To get started with this blank [[TiddlyWiki]], you'll need to modify the following tiddlers:
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* [[MainMenu]]: The menu (usually on the left)
* [[DefaultTiddlers]]: Contains the names of the tiddlers that you want to appear when the TiddlyWiki is opened
You'll also need to enter your username for signing your edits: <<option txtUserName>>

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Create a drop-down list of all recent : <<tag [[(a) Work in Progress - Major change]]>>
* ''We do not track extremely minor content changes'', such as fixing broken links, correcting typos, or improving the layout - members of the [[AMBIT Editorial Group]] work independently on these "housekeeping" tasks.
* ''Major changes'' require more "sign-off" than ''Minor changes''
!(a) Work in Progress - Major change
This is used to [[tag|Tags]] changes flowing from group discussions in the [[AMBIT Editorial Group]] and in order to be posted in the AMBIT manual they require a minimum of three members to agree, but to be properly accepted they require sign off from at the very least the significantly more for the highest level changes proposed.
The highest level of major changes mark a response to new evidence drawn from wider theoretical/experimental advances. They generally mark a //significant change in direction// (the removal of one of the [[Specific interventions]], or addition of a new one, for instance; or a change to the [[Core Features of AMBIT]] represented in the [[AMBIT Wheel]].)
!(b) Work in Progress - Minor change
This [[tags|Tags]] changes that are generally new pages that introduce some small element of new theory of practice, or which are formed to better elaborate an existing area, but which do not represent any kind of fundamental shift in direction or practice - but are rather "clarifications" or "embellishments" on existing content.
For example:
* The response to a local outcomes evaluation by a local AMBIT-influenced team that demonstrates wide applicability for other teams, but comes without the assurance of a randomized controlled trial.
* These changes are more likely to be smaller //components of practice//, or examples of stylistic approaches to a problem.
* The practice recommendation or "example" will be judged as marking a subtle shift in the direction of the "steer" that has previously been offered by the manual, although not one that - if all other things remaining unchanged - would be likely to have a significant impact on outcomes.
** For instance, the addition of video illustrating a technique for introducing the use of playing cards developed as a young persons' version of the [[AIM Cards]] - this (new) approach to the use of the cards (themselves an innovation from the AFC, building on the Clinician-rated [[AIM Form]]) was developed locally and evaluated locally in the AMASS team in Islington. It was agreed in the Editorial Group that this approach, while without formal validation evidence, was worth sharing as by doing so there may be scope for a formal validation exercise.)

Drop down list of all recent : <<tag [[(b) Work in Progress - Minor change]]>>
* ''We do not track extremely minor content changes'', such as fixing broken links, correcting typos, or improving the layout - members of the [[AMBIT Editorial Group]] work independently on these "housekeeping" tasks.
* ''Major changes'' require more "sign-off" than ''Minor changes''
!(a) Work in Progress - Major change
This is used to [[tag|Tags]] changes flowing from group discussions in the [[AMBIT Editorial Group]] and in order to be posted in the AMBIT manual they require a minimum of three members to agree, but to be properly accepted they require sign off from at the very least the significantly more for the highest level changes proposed.
The highest level of major changes mark a response to new evidence drawn from wider theoretical/experimental advances. They generally mark a //significant change in direction// (the removal of one of the [[Specific interventions]], or addition of a new one, for instance; or a change to the [[Core Features of AMBIT]] represented in the [[AMBIT Wheel]].)
!(b) Work in Progress - Minor change
This [[tags|Tags]] changes that are generally new pages that introduce some small element of new theory of practice, or which are formed to better elaborate an existing area, but which do not represent any kind of fundamental shift in direction or practice - but are rather "clarifications" or "embellishments" on existing content.
For example:
* The response to a local outcomes evaluation by a local AMBIT-influenced team that demonstrates wide applicability for other teams, but comes without the assurance of a randomized controlled trial.
* These changes are more likely to be smaller //components of practice//, or examples of stylistic approaches to a problem.
* The practice recommendation or "example" will be judged as marking a subtle shift in the direction of the "steer" that has previously been offered by the manual, although not one that - if all other things remaining unchanged - would be likely to have a significant impact on outcomes.
** For instance, the addition of video illustrating a technique for introducing the use of playing cards developed as a young persons' version of the [[AIM Cards]] - this (new) approach to the use of the cards (themselves an innovation from the AFC, building on the Clinician-rated [[AIM Form]]) was developed locally and evaluated locally in the AMASS team in Islington. It was agreed in the Editorial Group that this approach, while without formal validation evidence, was worth sharing as by doing so there may be scope for a formal validation exercise.)

! NOTICE FROM THE AMBIT PROJECT TEAM <br>
(ANNA FREUD NATIONAL CENTRE FOR CHILDREN AND FAMILIES)
Frequent visitors will have noticed warnings about an impending move for all the AMBIT manuals.
THIS MOVE IS NOW PARTIALLY COMPLETE!
!!!Just browsing content:
For users who just want to refer to content in versions of the AMBIT manual (or their local version), you should notice very little difference at all. The same original URL (web address) will still open the manual, but sharp-sighted visitors will notice that the address that actually loads is now different (at present it is a version of https://spaces.xememex.com/ambit, but in a short while this will change again to: manuals.annafreud.org/ambit - DO NOT WORRY ABOUT THIS! The content (local edits and core content hosted by the Anna Freud National Centre for Children and Families) is all preserved. It should all work just as before. If you notice any GLITCHES - please email anna.smith@annafreud.org with details so that we can fix it.
!!!Wanting to edit my local version:
If you are an active “manualizer” (ie you are regularly writing about the learning from your local team in a local version of the AMBIT manual) then you will find that logging in and editing is currently suspended (you can look but you cant touch, so to speak). This is ONLY TEMPORARILY! You can still add material, but just while we finish phase 1 of this major upgrade, the process for this will be slightly “clunky” you will need to email edits that you want added to: anna.smith@annafreud.org who will upload these edits for you.
!!!WHY ALL THIS CHANGE?
We have been very lucky to be supported with free web-hosting from BT until now, but this generous offer is no longer viable and it is time for the AMIT manuals to stand on their own feet. The AMBIT project is thus embarking upon a major upgrade and improvement of the manuals. Initially (now) they are just "moving house", but the user experience will start to improve very significantly later in 2017 (faster, easier better searching and editing, easier richer communication across the large AMBIT [[Community of Practice]] so that the manuals will become a new forum for discussing points of practice with practitioners from across the world.
!!!WANT TO SUPPORT THIS WORK? SPONSOR US!
<html><iframe width="560" height="315" src="https://www.youtube.com/embed/ewVrXLIHB-g" frameborder="0" allowfullscreen></iframe></html>
Contact anna.smith@annafreud.org to help fund this award-winning open source approach to developing better help for very vulnerable people. Thank you.
!What's here? (scroll down for content)
|bgcolor(lightblue): Supporting local teams to implement [[AMBIT training]]: a local team's developing practice can be recorded here, alongside [[evolving AMBIT "core content"|Dynamic, adaptive Manualization]]. <br><<slider chkNoteToNewUsersSlider [[Note to NEW USERS]] "Note to NEW USERS Â»" "Click here to get started learning how to use this website, which is similar - but a bit different - from other ones">> <<slider chkOurTeamandAMBITSlider [[Our Team and AMBIT]] "About OUR TEAM and the AMBIT COMMUNITY Â»" "Click here to read about OUR team, what the the AMBIT Community of Practice is writing about, changes to the core content of AMBIT, and NEWS from the AMBIT project at the Anna Freud Centre">><br> |
|bgcolor(pink): If your local team is recording its <<tag [[Supervision Notes]]>>, then access them here. |
!!!What's AMBIT?
[[AMBIT: an overview]] is a good place to start, or dive in straight away and click on sections of the wheel you want to explore. ''Scroll down for more content and signposting.'')
[img[AMBIT wheel 2014_SMALL]]<<imageMap MapWheel_2014>>
The basics of the [[AMBIT Wheel]], which represents the [[Core Features of AMBIT]], are explained here:
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!!!''@@color(#6C6F74):Shortcuts: click icons to access content:@@''
[img[AMBIT Manual Front Door|http://ambit-theme-v3-test.tiddlyspace.com/getting-started-icons.png]]<<imageMap MapFrontDoor-v3>>
No icons above? See below for text links - [[your IT system may have blocked access to pictures|Organisational support for the technology to run TiddlyManuals]]
!!!''@@color(#6C6F74):Specific tasks@@''
*''[[I want a brief introduction to AMBIT|AMBIT: an overview]]''
*''[[I want to learn about using this TiddlyManual|Using the Manual]]''
*''[[I am just starting work with a client|INITIAL PHASE]]''
*''[[I am already working with a client; where next?|INTERVENTION PHASE]]''
*''[[I want to look up a specific piece of information, or surf and browse|Find your way around]]''
*''[[I just want to fill an AIM questionnaire|AIM Form]]''
*''[[I am authorized to edit to our local team's manual]]''
*[[I want to find out about AMBIT training|AMBIT training]]
*''[[None of the above!]]''
!Everything connects!
Because all the pages have [[Links]] (or "references") to one another, we can list out the 30 ''most-referenced pages'' here (//the bigger the page title, the more references to it//). Click on any of the page titles to see a drop-down list of all the references to it in the manual:
|bgcolor(lightblue): <<cloud references action:popup limit:30>> |
!!!''@@color(#6C6F74):Who is this manual for?@@''
This manual is primarily for WORKERS, but it is OPEN SOURCE so that if clients or other interested parties are interested they are welcome to look, too - and some local teams encourage their clients to help them author new material, or improve existing pages (see [[here|http://ambit-casus.tiddlyspace.com/#%5B%5BInvitation%20to%20our%20Clients%5D%5D]]). See [[Who is this manual for?]] and [[Current versions of the AMBIT manual]]; that page is just one of the [[Comparing and Sharing functions]] that support AMBIT as a growing [[Community of Practice]].
!!!''@@color(#6C6F74):Recent Changes@@''
The content of this manual is constantly updating - track recent changes here:
<<recentChanges 90>>
!!!''@@color(#6C6F74):Important Legal stuff:@@''
There are important issues relating to [[Security and authorization]] to use this manual, and by going on into the manual you are agreeing to abide by the rules laid out.
!!!''@@color(#6C6F74):Feedback:@@''
You are invited to give [[Feedback please!]]
!!!''@@color(#6C6F74):Sponsors:@@''
The AMBIT project is grateful to Comic Relief and their other [[Sponsors]], without whom this manual would not be possible.

!Why am I here?
* Your team are going to address some of your existing: <<tag [[Local Manualization Homework Tasks]]>>
* You want to author brand new content for your team's local version.
* Your team has identified ''an area of your work that is not covered adequately in the manual, and want to describe it in better terms, or adapt it to fit your local culture, service ecology, etc.'' - you may be in the wrong place; why not go to the page that needs improving, switch to [[Edit mode]], and edit that page directly, or via its [[Show references and Info]] panel click the "create new sub topic" button.
* You are looking for what your team has //already manualized// - you are in the wrong place; go to [[List LOCAL EDITS to the manual]]!
!What to do
* Below this text and the AMBIT Wheel is a colourful box of buttons. Select the broad colour-coded category for the area of work that you want to "[[manualize|Manualization]]", then click that button to open a "blank page", and start writing - there is advice on how to do this at "[[Edit]]"!
<<image [[AMBIT wheel 2014_SMALL]] width:350 height:300>>
|bgcolor(lightgray):''Directly below this sentence, you should see a set of buttons'' (if you //don't see them//, follow the instructions below at @@color(purple): __''WHERE ARE THE BUTTONS?!''__ @@...) |
!Manualizing buttons:
|bgcolor(pink): <<newJournal label:"Manage RISK item" focus:title text:"Add your content here. Check you are not duplicating content; search for existing pages with your intended title!" title:"Type brief title here" tag:"Manage RISK""Local Protocols">> |bgcolor(pink): New item about how we manage RISK |
|bgcolor(pink): <<newJournal label:"Manage CLIENT RELATIONSHIP item" focus:title text:"Add your content here. Check you are not duplicating content; search for existing pages with your intended title!" title:"Type brief title here" tag:"Manage CLIENT RELATIONSHIP""Local Protocols">> |bgcolor(pink): New item about managing the relationship |
|bgcolor(pink): <<newJournal label:"Manage CLINICAL PROBLEM item" focus:title text:"Add your content here. Check you are not duplicating content; search for existing pages with your intended title!" title:"Type brief title here" tag:"Manage CLINICAL PROBLEM""Local Protocols">> |bgcolor(pink): New item about face to face "field work" |
|bgcolor(lightgreen): <<newJournal label:"Working with NETWORK item" focus:title text:"Add your content here. Check you are not duplicating content; search for existing pages with your intended title!" title:"Type brief title here" tag:"Working with your NETWORKS""Local Protocols">> |bgcolor(lightgreen): New item about multi-agency or multi-professional working |
|bgcolor(lightgreen): <<newJournal label:"LOCAL RESOURCE record" focus:title text:"Add your content here. Check you are not duplicating content; search for existing pages with your intended title!" title:"Type brief title here" tag:"Our Resources">> |bgcolor(lightgreen): New item about useful resources in the local area |
|bgcolor(yellow): <<newJournal label:"LOCAL Teamwork & Governance item" focus:title text:"Add your content here. Check you are not duplicating content; search for existing pages with your intended title!" title:"Type brief title here" tag:"Local Protocols""OUR LOCAL Teamwork and Governance">> |bgcolor(yellow): New item about teamworking practices |
|bgcolor(yellow): <<newJournal label:"SUSTAIN best practice item" focus:title text:"Add your content here. Check you are not duplicating content; search for existing pages with your intended title!" title:"Type brief title here" tag:"SUSTAIN best practice""Local Protocols">> |bgcolor(yellow): New item about holding on to learning in the team |
|bgcolor(yellow): <<newJournal label:"New Local AMBIT training session plan" focus:title text:"Add your content here. Check you are not duplicating content; do remember to search for existing pages with your intended title!" title:"Type brief title here" tag:"SUSTAIN best practice""Local Protocols" "AMBIT training" "Local AMBIT training session plans" >> |bgcolor(yellow): Create new session plan for a LOCAL training session |
|bgcolor(lightblue): <<newJournal label:"Make a new Local Manualization Homework Task" focus:title text:"Describe the element of your local practice that you want to attend to at your next team manualizing session. Check you are not duplicating content; search for existing pages with your intended title!" title:"Type brief title here" tag:"Local Manualization Homework Tasks">> |bgcolor(lightblue): ...know what needs doing but no time //now// (make reminder) |
|bgcolor(lightblue): <<newJournal label:"Make a new Supervision Note" focus:title text:"Make notes of the team learning points (NOT confidential clinical material!) from a team supervision session" title:"Type brief title here" tag:"Supervision Notes">> |bgcolor(lightblue): Record learning (NOT patient details!) from team supervision |
|bgcolor(lightblue): <<newJournal label:"Blank Page" focus:title text:"Add your content here. THINK HOW YOU WANT TO TAG THIS PAGE TO LINK IT TO EXISTING CONTENT! Check you are not duplicating content; search for existing pages with your intended title!" title:"Type brief title here" tag:"Local Protocols">> |bgcolor(lightblue): A new blank page (think how you will [[Tag|Tags]] this) |
!@@color(purple):WHERE ARE MY BUTTONS?!@@
>@@color(purple):You must be both [[logged in|Log in]] as a ''MEMBER of this space'', __and__ the manual must be switched to ''EDITING MODE'' (see the [[Mode and Login panel]] top right), in order to see any of the content editing buttons displayed above!@@
>@@color(purple):If you have switched to [[edit mode|Mode and Login panel]] //after this page was already opened//, then you will just need to //close and re-open this page// to reveal the editing buttons. (Hint, you can use the [[History recorder]] to find this page again!)@@
!Help!?
* See [[Manualization Boundaries]]: __''NB this is a TEAM TASK''__, not an individual team member's choice...
* See [[Video introduction to editing a tiddlymanual]] which demonstrates how to do this.
!Tips on what to manualize?
* See also existing __''@@color(blue):|<<tag [[Local Manualization Homework Tasks]]>>|@@''__ where outstanding manualization tasks for a local team are listed.
!Technical fixes
Use the [[Feedback please!]] form to give technical reports of glitches, or other suggestions for improvements, please.

!description
Young person is involved in non-mandatory organized school or community activities, such as sports, clubs, church groups, etc.
!end of description
!breakdown
''0+'' = Actively engaged in range of social activities.<br>
''0 = No problem''. Regularly involved in at least one social activity e.g. club, sports team.<br>
''1 = Mild''. Periodic involvement but inconsistent, attendance, Actively, regularly involved in at least one social activity.<br>
''2 = Moderate''. Attends some activities sporadically, but not very involved in any one/does not maintain involvement.<br>
''3 = Severe''. Rare involvement or interest in organised activities, usually attends single occasion only.<br>
''4 = Very severe''. Has been repeatedly asked to leave social activities because of behaviour problems.<br>
!end of breakdown

You may find it helpful to read two recent papers and a book chapter written about AMBIT: [[Fuggle et al (2014) The AMBIT approach to outcome evaluation and manualization: adopting a learning organization approach]], [[Bevington et al (2012) Adolescent Mentalization-Based Integrative Therapy (AMBIT)]], and [[Bevington D, Fuggle P (2012) Supporting and enhancing mentalization in community outreach teams...]]
It may also be helpful for you to read the following pages in the manual: [[AMBIT: an overview]] and [[Core Features of AMBIT]]

!description
Attendance at School, Emplyoment or Training courses. This is a measure of the extent of meaningful activity in the young person's life Behaviour and attainment are coded separately. Rate the attendance by the young person in the most recent academic, training or work environment, during the most recent 3-month period for which information is available.
!end of description
!breakdown
0+ = Attending at an above average level; e.g. particularly committed and working long hours productively.<br>
0 = No problem. Attending Education, Employment or a Training course for most or all of the working week.<br>
1 = Attending satisfactorily, but only part-time or on a reduced timetable on account of difficulties, so that some days during the working week are without meaningful activity. Occasionally truants or refuses to attend scheduled activities.<br>
2 = Moderate problems with attendance - misses days or parts of days on most weeks, with or without the knowledge of parents or carers.<br>
3 = Severe. Missing more time than than attending, and very clear detrimental effect on progress at place of work.<br>
4 = Very severe. Rarely attends, if at all; at high risk of exclusion/dismissal, or has entirely dropped out of Education, Employment or Training.
!end of breakdown

See [[AMBIT training]] for all the details.
There are two main training options available for your consideration:
*Training the whole Team: Multi team trainings are aimed at small teams (of 5-16 members) from either voluntary or statutory sector, and will be based at the [[Anna Freud National Centre for Children and Families]]. Small teams are trained together with other teams of roughly the same size. The format of the training is usually 2 core consecutive training dates for the whole team, followed by a training date specifically for AMBIT Leads roughly 1 month later, followed by a Start up Training for the whole team roughly 6-8 weeks after the initial training day. Bespoke training dates can be organised for larger teams (>16 members). This standard 3 day team training costs £375 per person (AMBIT Leads will get a 4th Day of training free of charge) and voluntary sector teams will receive up to a 50% discount based on annual income.
Please see the [[Centre's website|http://www.annafreud.org/courses.php/14/ambit-training-for-teams-4-days]] or contact [[Marta Wojciechowska|mailto:Marta.Wojciechowska@annafreud.org]] for upcoming dates for this type of training
*The Train the Trainer AMBIT model: designed to make training more sustainable and affordable for teams; two members in a team are given an extensive five day AMBIT training which includes training on how to run trainings for the rest of their team. These local trainers are then supported in implementing the approach in their team through webinars led by the AMBIT project for twelve months following training. The cost of this training is £1,500 per person (a minimum of 2 people per team must attend) and voluntary sector teams will receive up to a 50% discount based on annual income.
Please see the [[Centre's website|http://www.annafreud.org/courses.php/112/ambit-train-the-trainer]] or contact [[Marta Wojciechowska|mailto:Marta.Wojciechowska@annafreud.org]] for upcoming dates for this type of training.

!description
Functioning in school, employment or training; includes academic performance and behaviour. Since intellectual ability is recorded elsewhere, do not adjust this rating for perceived ability. Rate how the young person is functioning in the most recent academic or work environment, during the most recent 3-month period for which information is available.
!end of description
!breakdown
0+ = Working at above average level, areas of strength. Good reports from teachers or employers.<br>
0 = No problem. Working at least at an average level; may have some areas of weakness and/or strength.<br>
1 = Mild. Working below year level in at least one academic area, working satisfactorily in others. Employer recognises certain problems (timekeeping, workrate, etc) but they do not threaten employment status.<br>
2 = Moderate. Significant academic problems in several areas (e.g. fails maths and science exams), receives formal warnings from employer.<br>
3 = Severe. Consistently working below year level in most areas e.g. D average if graded. Threatened dismissal from work.<br>
4 = Very severe. Far below year expectations in most academic areas e.g. failing most academic classes, retained a year, dropped out of school, dismissed from employment or unemployed with little appreciable engagement with job-hunting.
!end of breakdown

See the [[AMBIT Training Application Process]]. One of the first stages of either training option is to organise a meeting or telephone conversation between an AMBIT Trainer from the Anna Freud National Centre for Children and Families, and your Team and Service Manager(s) to discuss your training needs further. After being introduced to the model, our hope is that Managers will then be able to continue on to engage their team members in a discussion about learning objectives before any training commences, with the aim of shaping the training content to the needs of the team.
Please contact [[Marta Wojciechowska|mailto:Marta.Wojciechowska@annafreud.org]] to go ahead with organising such a meeting.

!description
Skills/talents in activities such as athletics, art, music, mechanical, computers
!end of description
!breakdown
0+ = Very good. Young person excels in at least one area of interest, recognized by others as being talented or exceptionally skilled, e.g. wins art competitions, star basketball player, soloist in city-wide choir.<br>
0 = Good. Shows talent and persistent interest in at least one area, e.g. takes music lessons and plays in orchestra for several years,develops skills working on cars.<br>
1 = Average. Has some interests, and participates in individual or group hobbies or activities, but has not developed any one area where skills or abilities make him or her stand out.<br>
2 = Significant difficulties. Has few interests or activities, or moves quickly from one to another without persisting long enough to develop skills; e.g. joins soccer team and quits after a few weeks, tries an instrument but drops it when frustrated.<br>
3 = Major difficulties. No special interests or activities acknowledged by the young person.<br>
4 = Very severe difficulties - no one in the young person's network can identify interests or activities, even ones that were evident in the past.
!end of breakdown

Depending on the number of staff to be trained in your service (at least 16), it may be possible for us to run a bespoke training for you. However, as well as paying for the training itself, your team must also cover trainer expenses including travel and accommodation, and you must provide the training venue
Contact [[Marta Wojciechowska|mailto:Marta.Wojciechowska@annafreud.org]] for a quote.

We don’t routinely run AMBIT trainings outside of the UK, but we are sometimes commissioned by overseas teams to run bespoke trainings for them.
Depending on the number of staff to be trained in your service, it may be possible for us to run a bespoke overseas training. However, there is a 20% surcharge on overseas trainings, and as well as paying for the training itself, your team must also cover trainer expenses including travel and accommodation.
Another option is for two members of your team to attend the an International Train the Trainer Event, at the Anna Freud National Centre for Children and Families, London. See the [[Centre's website|http://www.annafreud.org/courses.php/113/ambit-train-the-trainer-for-international-teams]] or contact [[Marta Wojciechowska|mailto:Marta.Wojciechowska@annafreud.org]] for upcoming dates for this type of training.

!description
The extent to which the young person performs tasks such as hygiene, dressing, eating, and attention to personal health needs in age-appropriate manner; if the young person has not been given the opportunity to learn a particular skill (e.g. tie shoes because he has no shoes with ties), do not penalize, and rate on overall functioning.
!end of description
!breakdown
0+ = Good. Takes an active interest in maintaining good health and appearance; i.e. is aware of and maintains personal appearance, well turned out, good hygiene, healthy diet.<br>
0 = No problem. Maintains appearance, self-care to reasonable degree with little or no prompting.<br>
1 = Mild. Has skills but sometimes refuses or neglects self-care tasks, or has a circumscribed problem that does not affect social functioning seriously, e.g. compulsive hand washing.<br>
2 = Moderate. Substantive deficit in self-care in one area that impacts social functioning, e.g. daytime enuresis, unkempt appearance that leads to peer teasing.<br>
3 = Severe. Significant deficits in self-care in more than one area, impacting social and/or family functioning, or deficits impact health, e.g. diabetic teen does not monitor food and blood sugar.<br>
4 = Very severe. Significant deficits in most or all areas of self-care, cannot function independently to bathe, dress, and prepare for school, creating major family, social, and/or health problems.
!end of breakdown

See [[International Train the Trainer (TTT) Model]] for the curriculum.
The Train the Trainer model is designed to make training more sustainable and affordable for teams; two members in a team are given an extensive five day AMBIT training which includes training on how to run trainings for the rest of their team. These local trainers are then supported in implementing the approach in their team through webinars led by the AMBIT project for twelve months following training.
Opportunities to hear about the work of the centre will be included in the programme, including a talk from Anna Freud National Centre for Children and Families's Chief Executive Peter Fonagy.
The training price for the 5 day training, plus monthly supervision for 12 months is £2000 per person (2 team members per team must attend the training).
Contact [[Marta Wojciechowska|mailto:Marta.Wojciechowska@annafreud.org]] if you are interested in attending.

!description
Rating of general impairment or disability from any cause that limits or prevents movement, or impairs sight or hearing, or otherwise interferes with personal functioning. Includes impairment resulting from congenital conditions, side effects of medication, physical disabilities resulting from accidents, etc. DO NOT SELECT THIS AS A KEY PROBLEM if the disability is not amenable to change.
!end of description
!breakdown
0 = No physical impairment/disability.<br>
1 = Mild. Impairment/disability imposes mild restriction on activity/mobility, e.g. mild CP makes young person clumsy and impairs ability to compete in sports, hearing loss causes some problems in academic functioning.<br>
2 = Moderate. Restriction in significant areas of activity due to impairment/disability, severe seasonal asthma keeps the young person from participating in outdoor activities for several months each year.<br>
3 = Severe. Major restrictions in activity due to impairment/disability, e.g. confined to a wheelchair.<br>
4 = Very severe. Fully dependent. Activity/mobility severely restricted by impairment/disability e.g. quadriplegic, or confined to bed because of severe malnutrition related to anorexia.<br>
!end of breakdown

[[Guidance for Teams Considering Applying for Training]] can be found on the manual.
We only train teams that we believe will benefit from AMBIT training, and be able to translate the training experience into sustainable and effective changes in practice. One of the ways that we determine, together with you, whether AMBIT is right for your team is to organise a telephone conversation or meeting between an AMBIT Trainer from the Anna Freud National Centre for Children and Families, and your Team and Service Manager(s) to introduce you to the model, and to discuss your training needs further. We then ask teams to take part in a [[team audit|Pre-training team audit]] together, to discover what your learning objectives are.
Contact [[ambit@annafreud.org|mailto:ambit@annafreud.org]] if you have any further queries.

!description
Rate social development and maturity, in comparison with peers of the same culture and age. This item would cover (although is not limited to) the kinds of problems with social interaction that are commonly observed in pervasive developmental disorders such as the autistic spectrum. DO NOT SELECT THIS AS A KEY PROBLEM IF A DEVELOPMENTAL DEFICIT IS NOT AMENABLE TO CHANGE.
!end of description
!breakdown
0+ = Good. Young person is mature for age, interacts like an older young person, gets along with older peers, seen as 'mature'.<br>
0 = No problem. Young person is typical for age, similar to peers.<br>
1 = Mild. Slightly immature, noticeably ‘younger’ in behaviour/attitudes/awareness e.g. less aware of dress/music other areas of interest shared by peer group.<br>
2 = Moderate. Young person is markedly immature, tends to fit in with younger peers, has regular lapses in social judgement. <br>
3 = Severe. Social deficit. Seen as immature or ‘out of tune’ socially, difficulty fitting in to a peer group, either because of overt immaturity or inappropriate responses to social cues.<br>
4= Very severe. Widespread social deficit. Grossly immature, no or minimal ability to respond appropriately, perceived as misfit, rejected by all groups, isolated.
!end of breakdown

Where MBT is a very specific therapy, AMBIT is a much broader therapeutic approach. Some people have described AMBIT as "pretherapy" - but contained within AMBIT are manualized versions of a wide range of evidence-based approaches, including simple CBT, simple versions of MBT, MBT-F, Motivational work etc. The core training is for TEAMS and allows them to adapt how they use the materials in their own clinical setting.
To find out the difference between the different mentalization based courses that are offered at the Anna Freud National Centre for Children and Families there is an information sheet on the [[Centre's website|http://www.annafreud.org/data/files/Courses/CAI/MBT_courses_info_sheet.pdf]]
If you decide after reading the documents that the MBT training may be more suitable for you and you wish to find out more about this course or any other course that the [[Centre runs|http://www.annafreud.org/courses.php/]] then please contact [[Marta Wojciechowska|mailto:marta@annafreud.org]]

!description
Young person is engaging, likeable, interested in interacting with people. Social skills and interaction may be reduced for many reasons. For (lilfe-long) developmental problems in managing reciprocal relationships (such as autistic spectrum difficulties) see also item 08 Young person daily life - Social development.
!end of description
!breakdown
0+ = Good. Young person is likeable, has good social skills, actively enjoys and seeks out interaction with people of all ages.<br>
0 = No problem. Interacts adequately with most people, adequate social skills in relation to people of all ages.<br>
1 = Mild. Engages adequately with most people, has adequate social skills but some difficulties in interaction e.g. shy, hard to engage, awkward with some adults.<br>
2 = Moderate. Noticeable difficulties in peer and/or adult interactions, is withdrawn or interacts inappropriately at times.<br>
3 = Severe. Widespread difficulties in interaction, frequently inappropriate social skills, poor understanding of social cues. <br>
4 = Very severe. Serious problems in social skills or interactions, e.g. is isolated, has no friends, consistently misreads social cues or responds inappropriately, is consistently hostile and cannot maintain relationships
!end of breakdown

AMBIT is a 3 day training (4 days for AMBIT Leads, and 1 additional day that local teams are expected to hold locally before the final group training), and therefore cannot be delivered over one or two days.
However, we hold an AMBIT Conference annually, and although this is primarily for teams trained in AMBIT to share ideas about AMBIT practice, we do welcome interested individuals who would like to hear more about the AMBIT approach. However, please note that that the Conference won’t be an introduction to the AMBIT model. If you are interested in attending the next Conference, please contact [[Marta Wojciechowska|mailto:Marta.Wojciechowska@annafreud.org]]

!Keeping assessment integrated:
''NB Section A below is the least necessary information gathering activity that a KeyWorker will need to undertake in situations where an Education/Vocational Centre provision does //not// exist.''
The intention is always to integrate as much of the young person’s education/vocational realities into the overall treatment package to avoid the splitting that commonly exists between education and mental health services.
There is an [[Educational-Vocational Engagement Phase Flowchart]].
!SECTION A
''Preliminary information gathering and arrangements for attendance:''
!!!If young person is School Age (<16yrs):
(a) ''If attending school'':
Gather information from the YP and/or their family about their current education situation:
##Which school? Address? Phone number? Email address?
##What year?
##Name of tutor/head of year/SENCO?
##Position in relation to public examinations?
##Status of any course work/ deadlines missed or pending?
(b) ''If not attending school'':
##Who in the education service is, or should be, responsible for their education provision?
##Education Welfare Officer?
##Educational Psychologist involved?
##Learning mentor?
##Extend information by contacting relevant education professionals in the young person's school or college. Potentially the tutor, head of year, or SENCO (Special Educational Needs Cooordinator), in the first instance.
##Education history from records and teacher knowledge.
##Any Statement of Special Educational Needs?
###Current?
###In the past?
###Being applied for?
##Academic performance?
###Any pattern of deterioration?
##Knowledge about family circumstances? Any significant events/crises?
##Siblings/relatives in school?
##Peer group relationships? Friendship group? Isolation? History and any recent changes? Bullying? Drugs?
##Relationships with teaching staff?
##Relationships with ancillary staff?
##Public examination status?
##Course work situation, deadlines missed or pending?
##Other professionals or agencies known to be involved?
(d) ''School-age but not currently attending school:''
Information can be gathered from main school teachers, particularly the SENCO, as well as from Education Welfare Officers, Educational Psychologists, Learning Mentors or Connexions Personal Advisors (responsible for working with 13 to 19 year olds).
##How long out of school?
##Any legal action current or being contemplated?
## attempts to reengage YP in school? Who involved? What happened? Family participation/support?
##Current alternative education provision or attempt at provision?
##Other professionals or agencies known to be involved? Social Services, G.P.?
##Is there information about any previous exclusions and reports written for school governors?
!!!If above School Age:
##What educational level achieved?
###Exam results
###Basic literacy/numeracy skills
##Current employment status?
##Vocational Schemes, training, higher educational training?
##Aspirations regarding career and further educational opportunities?
!Engagement
Negotiation will need to take place between the KeyWorker and the young person, to get to (or be brought to) the Education/Vocational Centre.
##See [[Motivational Work]]
##See [[Engagement techniques]] for further detail.
##If the initial information gathering/liaison exercise turns up a significant professional or family member for the young person, they may be persuaded to accompany the young person on the first one or two occasions to the Education/Vocational Centre.
!SECTION B
''Key tasks and activities during first two weeks of actual attendance.'' - see an [[Example timetable during engagement phase]]
(a) ''Educational Assessment''
Educational tasks and activities to be given to the young person during teaching sessions to complement information already obtained from teachers and other education professionals. Because of individual or small group context the information gained will be both current and potentially more detailed than may have been available before.
National Curriculum levels in Literacy and Numeracy could be obtained, as well as getting a basic Reading Age.
A whole range of educational or psychometric tests could be used as deemed necessary for more detailed assessment profile.
(b) ''Social Assessment''
This is carried out by observing the YP in a range of contexts and activities in the education centre.
**Relationship with peers - observed in formal, semi-structured and informal contexts.
**Formal - observation of relationships in small group tightly structured teaching situations
**Semi-structured - observation in less formal activities drama, art, cooking etc.
**Informal - observation in breaks and free time around the education centre.
**Relationships with authority figures - observations made in similar contexts to above and in addition, during one-to-one conversations.
**Relationship to learning - observations made in teaching situations.
It is important to note that much information that will contribute to both the educational and social assessment will be derived from the "routine" teaching context. Everything that the young person does during this assessment phase shouldn't look only like assessment.
(c) ''Family Assessment''
As appropriate, relevant family members will be encouraged to participate in elements of the education programme. This will provide opportunities to observe relationships between the young person and their family in a range of contexts not normally available either on home visits or in mainly structured family interviews. The contexts will be based on both individual family as well as multi family activities. The information obtained will be additional to that gained in regular family interviews.
(d) ''Individual Assessment''
The young person will be withdrawn from the education programme group for individual interviews as necessary.

A lively conversation, sharing knowledge of AMBIT-influenced ways to engage with young people:
*Sharing a bit of ''me''. Purposeful self-disclosure. Balancing risk.
*Engaging young people "where they're at"
**physically - meeting in a place that is right for the young person - McDonalds and parks vs clinics and offices. Perhaps with a plan to gradually transition to a more conventional clinical or helping space.
**Psychologically - "Getting it"
*Finding ways to "step out of chaos", to reduce affect:
**activity (e.g. talking whilst playing pool)
**speaking in the car (reduced expectation of eye contact)
*Language that encourages mentalizing, e.g. "I'm interested to hear..."
*Language to share - tentatively - our own thoughts (see [[Broadcasting Intentions]]) e.g. "I guess my perspective is.... what's yours?"
*Importance of worker being "thick skinned"
**After further discussion it was considered that what was being referred to here was a maintenance of mentalizing capacity in the worker - in the sense of the worker being able to remain curious about the mental states underlying what might feel like difficult behaviours in a young person, not taking this behaviour "personally".
Unconferencers concluded that there were several strategies here which are rather different to traditional therapy or helping, and coined the term "Untherapy" to describe this!

!description
Child or young person's ability to access stable, appropriate housing. For older adolescents the assumption that the home is a //family// home may not be appropriate.
!end of description
!breakdown
0+ = Good. (Family) home is secure and young person stable within it.<br>
0 = No problem. (Family) home is stable, occasional conflicts are resolved without recourse to threats about eviction.<br>
1 = Mild. (Family's) tenure at home may be at risk, but not imminently so, or conflict at home results in occasional threats about the young person leaving, or having to leave home.<br>
2 = Moderate. Significant risk that the family/young person will lose tenure of the home, or that conflict will lead to permanent expulsion of the young person, who spends occasional nights with friends or relatives to avoid conflict.<br>
3 = Severe. Family/young person has no stable housing - accomodation may be temporary, and inappropriate, or young person may be spending significant periods out of the family home, either by choice or at the family's insistence, or is in temporary housing.<br>
4 = Very severe. Young person is homeless - staying with friends ('sofa-surfing'), or street homeless.
!end of breakdown

As AMBIT is a constantly developing model, we are always interested in new research possibilities, and our emphasis on [[Respect for Evidence]] means that we encourage [[Monitoring OUTCOMES]] and would be keen to pool results fro across teams.
However, we do currently (2015) have 3 doctorate studies underway; University College London PhD students are currently researching different aspects of AMBIT including Worker experience, Client outcomes, and Team outcomes.
Therefore please contact [[ambit@annafreud.org|mailto:ambit@annafreud.org]] with your research suggestion, so that we can see how this project could fit into our current ongoing research projects.

!description
Family's ability to provide concrete resources for the young person; e.g. financial stability, appropriate housing, clothing, etc. In the case of older adolescents living independently, this may refer to their capacity to access the same independently, via work or appropriate benefits.
!end of description
!breakdown
0+ = Good. Family/young person is financially secure and can access funds/resources as required to help the young person.<br>
0 = No problem. Family/young person is financially stable, has access to funds and resources to meet the young person's basic needs.<br>
1 = Mild. Family/young person is financially stable but resources are stretched to meet all of the young person's significant needs.<br>
2 = Moderate. Family's/young person's limitations are such that some of the young person's needs cannot be met e.g. very limited funds for clothing or pocket money.<br>
3 = Severe. Family/young person has great difficulty making ends meet, precluding meeting of some of young person's needs.<br>
4 = Very severe. Family's/young person's resources are very limited and constitute a serious problem for the young person e.g. cannot afford clothes or school equipment, family/young person runs out of money each month, erratic or absent health care because of poor access.<br>
!end of breakdown

No!
AMBIT is a team approach, therefore the training is only available to teams and not individuals. As an individual, you may be interested [[in other short courses|http://www.annafreud.org/courses.php/]] that the Anna Freud National Centre for Children and Families runs. To find out more please contact [[Marta Wojciechowska|mailto:marta@annafreud.org]]

!description
The quality of interaction and affection __between members of the immediate family__ (parents and siblings and others living in the home). If variable, rate the best available relationship.
!end of description
!breakdown
0+ = Good. Relationships are warm, confiding, including planned sharing of activities and enjoyment of each others' company.<br>
0 = No problem. Generally positive relationships, family members spend time together, no major conflicts.<br>
1 = Mild. Relationships are generally positive but with limited contact or expressed affection OR mild over-involvement.<br>
2 = Moderate. Relationships are neutral or distant, with only occasional shared activities or conversation; OR significant over-involvement.<br>
3 = Severe. Distant relationships, with no positive interaction or affection expressed, and rarely shared activities or conversation OR severely over-involved or enmeshed relationships.<br>
4 = Very severe. Relationships characterised by hostility, actively destructive, undermining of young person and other family members OR highly destructive level of enmeshed relationships/over-involvement.
!end of breakdown

AMBIT is a developing model of practice, and as such the evidence-base for its effectiveness is far from robust, even though early signs are encouraging.
See [[Evidence]], [[Is AMBIT evidence based?]] and [[Academic references]] pages on the manual for more information.

!description
The ways anger, conflict, and negative feelings are expressed and managed in the relationship; rate the relationship between the young person and the immediate family member in which there is the most problematic conflict.
!end of description
!breakdown
0+ = Family's conflict resolution skills are markedly strong - differences are recognised early, and can be explored honestly and effectively.<br>
0 = No problem. Anger and frustration are generally expressed and resolved with little or no long-term impact on the relationship.<br>
1 = Mild problem. Occasionally conflicts lead to residual feelings of frustration and tension that last several days, but most interaction is not coloured by effects of conflict.<br>
2 = Moderate problem. Persistent conflicts or periodic severe clashes; interaction is frequently coloured by conflict. Positive relationship undermined by impact of conflict.<br>
3 = Severe problem. Persistent serious conflict; the majority of interaction is characterized by hostility and conflict with minimal positive expression.<br>
4 = Very severe problem. Interaction with young person is dominated by conflict, e.g. cannot interact with ending up in a screaming fight.
!end of breakdown

We see attending conferences to speak about AMBIT, as a good way to advertise the approach to others, therefore we may be able to provide speakers, and we don’t aim to make a profit from such events. However, we do need to cover our costs so usually charge the raw cost of the speaker’s time, plus any travel and accommodation costs involved. Please contact [[ambit@annafreud.org|mailto:ambit@annafreud.org]] with speaker requests.

!description
Parent or caregiver's typical patterns of discipline, limits, and rule-setting for the young person; too harsh, inconsistent, or inadequate discipline may be a problem. If young person spends regular time in two households (e.g., divorced parents), and there are inconsistencies between discipline in the two, rate the effect of the combination of the two. If any indication of abuse, ensure that this is recorded in carefully in the history, and that Child Protection issues have been considered.
!end of description
!breakdown
0+ = A positive strength in the family. Clear boundaries that are managed without recourse to coercion, and are respected by the youth.<br>
0 = No problem. Generally consistent, clearly expressed and age-appropriate discipline with only occasional impatience or inconsistency.<br>
1 = Mild. Generally adequate discipline, but with lapses such as inconsistency in some areas, ignoring when young person breaks a rule, yielding to young person's persuasion against established policies, empty threats.<br>
2 = Moderate. Significant issues with discipline, such as frequent arguments between parents over discipline, frequent empty threats, frequent punishments inconsistent with the infraction, spanking for minor infractions, serious inconsistency, or very lax or inadequate discipline, where parent only responds when alerted by outside sources.<br>
3 = Severe. Frequent harsh, humiliating, or rejecting punishment, e.g., refusing to speak to the young person for hours, beats young person with a belt, or no attempt at discipline at all.<br>
4 = Very severe. Sadistic, extreme, abusive discipline, e.g., tying young person to a bed all day, beatings which cause injury.
!end of breakdown

Although the AMBIT course was originally created for teams working with complex adolescents, it has now broadened to teams working with complex cases in general - and we have trained those working with families, early years, and young adults as well as adolescents. The material on the manual is sometimes more geared towards working with adolescents, however, the idea of the manual is for it to be customised by local teams so that the material works for their own client population.
AMBIT is really a set of Core Principles (the [[Core Features of AMBIT]]) which, integrated via the theory of [[Mentalization]] and other major [[theories|Theory]], offers a platform for local teams to develop evidence-based, or at least evidence-oriented practice.

!description
Describes relationships with adults outside the family, such as teachers, coaches, neighbours, parents of friends, aunt or uncle, pastor, etc.
!end of description
!breakdown
0+ = Good. Has an enduring, close relationship with a helpful adult outside the family, to whom he or she turns for advice,
comfort, and practical support on a regular basis.<br>
0 = No problem. Has relationship with a helpful adult outside the family; this person is available in times of crisis.<br>
1= Mild. Has relationship with helpful adult(s) outside the family but person may not be involved in the young person's day-to-day life or always available in times of crisis.<br>
2 = Moderate. Has generally supportive relationships with some adults, but does not identify any one in whom confides or relies on regularly.<br>
3 = Severe. Relationships with adults outside the family are neutral or distant, cannot envision asking for help or advice.<br>
4 = Very severe. So mistrustful of adults outside the family that he or she actively rejects offers of help.
!end of breakdown

We have a pricing structure that is designed to keep prices to an absolute minimum, as we know that access to training budgets for whole teams is imited. The pricing structure does get updated fairly regularly - not least because we are constantly updating and adapting the ways that we deliver training to get maximum value for money, so please check with [[ambit@annafreud.org|mailto:ambit@annafreud.org]] for the most up to date pricing structure.
We offer discounts to voluntary sector teams of up to 50% based on annual income.
If you are part of a large team and it is too costly to send the whole team to a training, then our new [[Train the Trainer AMBIT model|http://www.annafreud.org/courses.php/112/ambit-train-the-trainer]] may be an option to consider; the cost of this training is £1,500 per person (a minimum of 2 people per team must attend) and voluntary sector teams will still receive up to a 50% discount based on annual income.

!description
The extent to which the young person seeks out, relates to, and becomes attached to peers
!end of description
!breakdown
0+ = Good. Enjoys/seeks out peers, identifies peers as friends, interacts with a range of peers, admired within peer group.<br>
0 = No problem. Mixes with peers, seen as 'one of the gang', no obvious difficulties with peers.<br>
1 = Mild. Mixes with peers but slow to warm up and form relationships e.g. does not respond initially to friendly overtures from peers, but does interact and engage in some situations.<br>
2 = Moderate. Interacts socially at times, but does not form relationships that persist from one time to the next; or, extremely selective, will only interact with one or two individuals. Tends to be 'a loner'.<br>
3 = Severe. Rarely engages with peers; may watch peers, but does not interact. Not perceived as part of peer group.<br>
4 = Very severe. Shows no interest in peers at all, ignores or treats them as objects. Rejected by peers.
!end of breakdown

We are happy to consider top up training requests, but would also like to think with you about whether the AMBIT Leads from your service could assist in the delivery of top up trainings. An example curriculum is provided here [[Follow-up training for established teams]] but this is highly adaptable to suit the needs of the team.

!description
The extent to which the young person’s friendship group is identified as pro-social or antisocial.
!end of description
!breakdown
0+ = Good. Positive links to socially responsible group, engages exclusively in prosocial activities (sports, clubs, community projects, etc) with these.<br>
0 = No problem. Mixes with peers who are generally accepted as prosocial, may know antisocial peers, but is not unduly influenced by them, and does not engage in activities alongside them.<br>
1 = Mild. Has occasional contact with young people associated with antisocial groups/gangs, and occasionally witnesses antisocial activities carried out by these.<br>
2 = Moderate. Counts antisocial peers amongst friends. Has regular exposure to antisocial activities in their presence, and occasionally takes part in these.<br>
3 = Severe. Majority of friendship group could be classified as antisocial, and most leisure time is spent in their company. Regularly engaging in antisocial behaviours alongside this peergroup.<br>
4 = Very severe. Strongly and almost exclusively identifies self as gang member. Regularly engaged in gang-related activities including significant offending behaviours.
!end of breakdown

We are very keen to encourage conversations between teams, as AMBIT seeks to promote and support a vital [[Community of Practice]] - so we encourage relations between teams to continue once training has been completed. The AMBIT manual is just one of the ways that we encourage teams to share their local knowledge and practice with each other.
Contact [[Marta Wojciechowska|mailto:Marta.Wojciechowska@annafreud.org]] who will contact a team similar to yours to see if they would be happy for their contact details to be passed on.

!description
Young person is bright, quick to learn, able to comprehend.
!end of description
!breakdown
0+ = Very good. Young person is well above average in intelligence, seen as 'gifted'.<br>
0 = Good. Young person is above average in intelligence, seen as 'bright', learns easily.<br>
1 = Average. Young person has average-range intellectual abilities.<br>
2 = Significant difficulties. Young person has below-average intellectual abilities, 'slow', struggles to learn.<br>
3 = Major difficulties. Has cognitive disabilities (not learning difficulty alone).<br>
4 = Severe difficulties. Cognitive disability is apparent to anyone who meets the young person.
!end of breakdown

!description
Includes irrational fears and phobias, general anxiety, worries, and panic-like symptoms, repeatedly asking questions and seeking reassurance, or restless, agitated behaviour if clearly associated with anxiety. These will often be provoked by new situations or people in milder forms, or more pervasive fears and inhibitions at higher levels of severity.
!end of description
!breakdown
0+ = A strength. Recognised as someone who can remain calm under pressure, and yet mindful of risks.<br>
0 = No problem. Anxiety is transient and appropriate to the situation.<br>
1 = Mild. Often anxious, reluctant to try new things, but in familiar surroundings is comfortable; may worry or ruminate more than is typical.<br>
2 = Moderate. Often anxious such that s/he is inhibited and refuses to engage or try new activities, sometimes is anxious or inhibited even in familiar settings; worries, fears, or panic attacks restrict some activities.<br>
3 = Severe. Anxiety often interferes with functioning at school, home, or with peers, and is noticed with concern by teachers or other observers; e.g. anxiety and phobias lead to very limited activities outside of school, in spite of interest and desire to participate.<br>
4 = Very severe. Anxiety pervades daily functioning and interferes with normal tasks of development; e.g. refuses to go to school because of separation or social anxiety, frequent major panic attacks, etc.
!end of breakdown

!Intervention
As the educational assessment becomes completed there is an increased capacity to tailor the academic/vocational element of the programme more specifically to meet the needs of the young person.
There is an [[Education-Vocation Intervention phase - Example timetable and Flowchart]].
This may involve more public exam work or support for course work. Alternatively, it may become clear that more sophisticated teaching delivery is required in relation to a YP's specific learning difficulty. This may entail intensive literacy or numeracy input.
Equally, as the social assessment information becomes available, the individual and family targets and objectives will become clearer and the programme can be adjusted accordingly.
The basic structure of the sample timetable above will remain the same but with an increasing emphasis on making the necessary connections with the young person's future placement after leaving the Education/Vocational Centre. This may involve meetings with the school, further education college or work experience placement professionals. The Connexions Personal Advisers will be particularly useful in helping to facilitate this transition as they have the responsibility for working with young people to help them negotiate any of these moves.
The young person should reduce attendance at the Education/Vocational Centre to 3 sessions per week at some stage during the second phase. This is to support their reintegration back to school or their transition into college or work experience placement whilst they are still part of the Education/Vocational Centre programme and available to get the most support from it.

An unconferencer posed the challenging question "Do you mentalize at home?". This led to a conversation about the extent to which is it possible to sign up to ideas about the importance and helpfulness of efforts to maintain a mentalizing stance in one's work but not carry forward this philosophy in to one's personal life. This thinking about personal self opened up conversations about mentalizing that were rather different to those we often have. Participants shared their experiences of failures of mentalizing in conflict with loved ones, and of how the emotions involved in intimate relationships make inevitable such failures. The idea was put forward that a couple that does not ever argue might be in [[Pretend mode]], in failing to acknowledge and address differences and difficulties. There was acknowledgement of how much more //comfortable// non-mentalizing positions can be at times, leading us to avoid mentalized positions even when we have become aware that is likely that we are in a non-mentalizing frame of mind:
*Sometimes we just want to be RIGHT, so certainty, or [[Psychic equivalence]] is the ideal position
*Sometimes we don't want to acknowledge things: [[Pretend mode]] works nicely
*Sometimes [[Teleological thinking]] is easiest and quickest (at least in the short term!)

!description
Obsessional ideas are recurrent, persistent thoughts, impulses, or images that enter the mind despite the person's efforts to exclude them, often recognized by the person as unrealistic. Compulsive behaviours are repetitive and purposeful behaviours associated with a subjective sense that they must be carried out, e.g. checking, washing.
!end of description
!breakdown
0 = No problem. No obsessive or compulsive symptoms, can tolerate changes in routine without anxiety.<br>
1 = Mild. Adherence to routines or habits, with some anxiety or anger when interfered with e.g. perfectionistic regarding homework and spends extra time each night checking and double-checking.<br>
2 = Moderate. Routines and fixed ideas impact functioning and cause conflict or require major adaptation by caregivers, e.g. family must rearrange schedule to accommodate hour-long showers twice a day, preoccupation with intrusive thoughts causes daily distress.<br>
3 = Severe. Obsessions or compulsions dominate daily functioning and interfere with social and cognitive development, e.g. compulsive counting/checking interferes with schoolwork, pervasive preoccupation with cleanliness leads to isolation and restriction of activities.<br>
4 = Very severe. Incapacitated by rituals or compulsions, e.g. refuses to leave home because of fears of contamination, cannot speak or move because of indecision
!end of breakdown

!This is a SAMPLE ...delete it
Focus on family relationships. Reduce mother's tendency to escalate and amplify X's own frusrations.
Mentalizing approaches
End with clear contingency plan for what to do when X is getting upset.

!description
Recurrent trauma-related thoughts, images, feelings, or behaviours that have a highly charged, frightening, or overwhelming quality, are associated with emotional arousal, and which enter the person's mind in a manner that is beyond voluntary control. Includes intrusive memories, nightmares, flashbacks, reenactments. Excludes depressive ideation, obsessional ideas, or ideation associated with specific phobias.
!end of description
!breakdown
0 = No problem. No evidence of problem with post-traumatic intrusive experiences.<br>
1 = Mild. Thoughts, images, behaviours, or feelings that are transitory, voluntarily controlled, limited in intensity and do not interfere with normal functioning e.g. is reminded of an abuser by current stepfather, but maintains a distant yet congenial relationship.<br>
2 = Moderate. Thoughts, images, behaviours, or feelings that are intense and cause significant distress and disruption in functioning, but can be voluntarily contained e.g. young person listens to music for hours to block out intrusive ideation.<br>
3 = Severe. Thoughts, images, behaviours or feelings that are intense, easily triggered, cannot be voluntarily contained, and cause severe distress and major disruption in social and academic functioning, e.g. a boy has flashbacks to a traumatic beating when attending school, so is repeatedly truant and avoids school.<br>
4 = Very severe. Thoughts, images, behaviours, or feelings that are overwhelming and pervasive, causing intense personal distress and dominating daily functioning, e.g. after a rape, a girl panics whenever she sees a man, jumps at any sound, and so withdraws to her home, where she hides in her room and suffers intense anxiety.
!end of breakdown

!description
The extent to which the young person can focus on a task for appropriate periods of time without distraction or interruption of concentrated effort, without one-to-one supervision or other individual attention. Rate typical behaviour, not lapses in attention due to fatigue or situation-specific factors.
!end of description
!breakdown
0+ = A noticeable strength. Parents and teachers comment on powers of concentration and capacity to remain on task, even during undesired but necessary activities.<br>
0 = No problem. Able to attend and concentrate on tasks for age-appropriate timespans - including tasks that are not immediately rewarding.<br>
1 = Mild. At times able to attend and persist at task for 45 minutes, but often (at least daily) is distracted, even from an activity s/he enjoys, unable to finish what s/he starts, or struggles to attend to tasks that are frustrating or require rote practice.<br>
2 = Moderate. Is rarely able to attend to a task for more than 30 minutes, other than activities such as TV or video games, teacher notes distractibility at school, cannot persist with frustrating or boring tasks.<br>
3 = Severe. Unable to attend to most activities for more than 15 minutes without some interruption or distraction, even those s/he enjoys; distractibility interferes with acquiring skills and information in school.<br>
4 = Very severe. Unable to focus on any task or activity for more than a few minutes, constantly distracted, severe problems with learning at school or completing other sorts of work.
!end of breakdown

!description
General level of response to frustration, disappointment, criticisms, or provocation. Includes irritability associated with manic states.
!end of description
!breakdown
0+ = A strength. Recognised by others as having a particularly even, placid temperament (without being passive, or timid.)<br>
0 = No problem. No unusual level of irritability; may respond irritably when tired, but generally even-tempered.<br>
1 = Mild. Responds more intensely than most, often seems crabby or irritable in response to mild frustration or disappointment.<br>
2 = Moderate. Often responds out of proportion to frustration or disappointment, yelling or crying; other people see the young person as hot-tempered or unpredictable.<br>
3 = Severe. Has major outbursts (e.g. yelling, crying, threatening) frequently, even to minor frustrations; these can significantly interfere with peer, family, and school functioning<br>
4 = Very severe. Has outbursts several times a day, and seems constantly angry or explosive; others avoid the young persons and may be afraid of his or her temper.
!end of breakdown

!description
Difficulties with sleep and arousal, including insomnia (difficulty initiating sleep), excessive daytime sleepiness, nightmares, night terrors, sleep apnoea, sleepwalking, and narcolepsy. Rated on the basis of how much distress and functional disturbance is associated with the problem, regardless of whether sleep is the primary concern.
!end of description
!breakdown
0 = No problem. May sometimes wake during the night, but sleeps again without difficulty, no persistent problems.<br>
1 = Mild. For example, consistent difficulty in going to sleep (up to 1 hr.), nightmares, or night waking causing daytime fatigue.<br>
2 = Moderate. Major difficulties that disrupt functioning, e.g. complains consistently of initial insomnia of more than an hour's duration; sleeping excessively during the day, sleepwalking that causes family disruption OR reversed sleep-wake cycle.<br>
3 = Severe. For example, nightly difficulties sleeping that leave them exhausted during the day and interfere with personal and/or family functioning, sleeping excessively during the day, narcolepsy symptoms interfere with school or social functioning, mania causes person to sleep only 3 hours per night.<br>
4 = Very severe. Nightly difficulties that constitute an acute risk to safety or development, e.g. agitated sleepwalking or night terrors that lead to aggressive or uncontrollable behaviour, young person in psychotic break does not sleep for several days.
!end of breakdown

!description
Depression may be manifest in sadness, tearfulness, irritability, lethargy, boredom, etc.; one of the principal factors being an inability to take pleasure in normally pleasurable things. Lack of activity or withdrawal associated with negative symptoms of psychosis are not rated unless there is clear evidence of dysphoric mood.
!end of description
!breakdown
0 = No problem. Is sad in response to normal stressors, appropriate range of affect.<br>
1 = Mild. Often sad, bored, or irritable, may cry often, is noticed by others as appearing sad, but also has periods of happiness and can engage in normal activities with pleasure.<br>
2 = Moderate. Seems sad, bored, or irritable much of the time, does not engage in normally enjoyable activities.<br>
3 = Severe. Appears sad, bored, irritable, or withdrawn almost all the time, cannot persist in normal activities, does not seem to derive pleasure from anything, may express morbid or suicidal ideation.<br>
4 = Very severe. Sad, tearful, or withdrawn almost all the time, is inactive and disengaged, cannot be cheered up by any intervention; sleep, appetite, and activity level may be affected; persistent morbid or suicidal ideation.
!end of breakdown

!description
Includes purposeful and self-injurious behaviour; excludes suicidal behaviour, or unclearly motivated behaviours which can or do result in injury. Ambiguous behaviours (e.g. punching a wall) may be considered self-injurious if repeated after causing pain or injury. Self-tattooing/piercing are considered self-harm, but professional tattooing or piercing are not.
!end of description
!breakdown
0 = No problems - no self-injurious behaviours reported.<br>
1 = Mild. Habits such as nail-biting or skin-picking lead to mildly disfiguring or painful conditions.<br>
2 = Moderate. For example, self-tattooing or mild self-cutting; punches fist into wall or window.<br>
3 = Severe. Repeated self-cutting; self-injury that requires medical attention; burning self.<br>
4 = Very severe. Self-injury is repeated and severe so that health or bodily integrity is threatened (e.g. cutting leads to infection and severe scarring).
!end of breakdown

!description
Includes all forms of eating disorders, whether restricting calories, binge eating with or without purging, pica etc. Increase or decrease in caloric intake as a result of depression or other problem is rated under Self Care (06). Includes not eating for reasons associated with delusional states e.g. belief that food is poisoned.
!end of description
!breakdown
0 = No problem. Normal eating habits for age.<br>
1 = Mild. Some concern with eating habits; e.g. restriction of eating to a few foods, chronic overeating in overweight person.<br>
2 = Moderate. Extreme restriction of type or quantity of food, or dramatic overeating (e.g. food must be locked up).<br>
3 = Severe. Food restriction or consumption constitutes a serious health problem e.g. over or under-weight so that physician recommends intervention, beyond dieting for overweight; binging and purging.<br>
4 = Very severe. Eating habits constitute an immediate threat to health, e.g. acute anorexia nervosa, purging from bulimia causes acute medical problems.
!end of breakdown

!description
Use of alcohol or illicit drugs (not cigarettes) without parental approval; culturally sanctioned use such as sips of parents' wine are not rated; in a restricted environment such as in young person unit or correctional facility, severity should be based on observations of attitude and interest expressed and apparent intentions regarding abstinence/treatment.
!end of description
!breakdown
0 = No problem. No use of alcohol or drugs, or only occasional (e.g. once a month) social use of alcohol.<br>
1 = Mild. Occasional use of alcohol or drugs, but with no adverse consequences or regular intoxication; while hospitalised or restricted, denies any problem with substance abuse and intends to continue social use.<br>
2 = Moderate. Use of alcohol or drugs to the point of intoxication at least once a week; while hospitalised or restricted, struggles with cravings, mixed motivation to abstain.<br>
3 = Severe. Frequent (more than twice a week) intoxication; substance use affects relationships, school, and/or work functioning; if hospitalised or restricted, craves substances, talks or thinks repeatedly about use, no plan to abstain.<br>
4 = Very severe. Substance use daily, in spite of adverse effects; while hospitalised or restricted, persistent cravings and attempts to obtain substances.<br>
!end of breakdown

!description
Suicidality is rated on the basis of both behaviour and ideation. There must be clear evidence of intention to cause self-harm to rate behaviour as a suicide attempt; accidental self-injury is not rated. Also, do not include injury or illness as a consequence of other symptomatic behaviour such as substance abuse or eating disorder, unless specific suicidal intent is expressed. Use the Risk Assessment and Care Plan if this scores >1
!end of description
!breakdown
0 = No problem - no suicidal thoughts, plans or intentions.<br>
1 = Mild. Reports suicidal ideation, or persistent hopelessness.<br>
2 = Moderate. Talks about persistent suicidal ideation, with some thought about a method or plan.<br>
3 = Severe. Suicidal gestures e.g. taking 5 pills, cutting wrists superficially and/or significant preparations toward a suicide attempt.<br>
4 = Very severe. Suicide attempt or potentially lethal gesture, e.g. takes bottle of Prozac, or clear preparations for a serious suicide attempt that are interrupted against the young person's will.
!end of breakdown

The group thought about biological, neurodevelopmental and social factors impacting states of mind in adolescents:
*Neurodevelopment - mentalizing capacity is fragile, fight or flight is strong
*Importance of transition: am I an adult yet? does this society view me as an adult? Loss of childhood? Mismatch between expectations and responsibilities and level of freedom/agency - mixed messages given
*Tendency to view young people as //bad// not //sad//
*Development of sexuality and implicit message that this is bad
*Uncertainty around multiple changes occurring, changing expectations
*Importance of understanding individual differences
*Difficulties and differences in help seeking and response to offers of "help"
*Do all adult workers understand these issues?
*Exams, decisions, stress!

!Background to Referring Crisis
Sixteen year old Darren was referred to the team by his family and friends, who had become extremely anxious and frightened by his abnormal behaviour during the past six hours.
He was a member of the local youth theatre and was performing in a production they were putting on at a local theatre. He had turned up for the show late and clearly under the influence of cannabis and alcohol. He was in an agitated state but insisted that he was all right to go on. Very quickly it became clear that he was not fit to continue as he was standing on the stage staring blankly around him disrupting the whole performance. He resisted attempts to persuade him to leave and had to be physically carried off. He did not calm down and had to be restrained when he started to bang his head repeatedly against the dressing room wall. He said he could hear voices telling him to kill himself. His family was called but neither his mother nor father was willing to come. However, his younger brother turned up to take him home. It took the two youth theatre leaders, one of Darren's friends and his brother to chaperone him back to his house. When his condition continued to deteriorate into the night the KW was called.
Because Darren was so agitated and a danger to himself and threatening violence particularly to his brother, in consultation with the psychiatrist the Keyworker decided to medicate him.
!Education Liaison -
During the next three days whilst the KW was doing intense work with Darren and his family in the home, the Education/Vocational Centre teacher/therapist contacted the SENCO of his school. She found out that Darren had a long history of disaffection and truancy since his transfer from primary school. However when he was at school he had been very good at drama and music and was said to be a talented drummer. He had poor relationships with most of the school staff but was well liked by one drama teacher who had encouraged him to join the youth theatre. He was in the middle of his GCSE final year but was way behind in virtually all of his course work and was in danger of not being entered for any of his exams. He was said to have no real friends at school and was described as a loner and a bit of an "oddball". In contrast, the SENCO said that Darren's younger brother was a high achiever, sporty and popular. The SENCO had only met Darren's mother but had been alarmed by her highly critical manner of talking about him.
On the fourth day, the KW felt confident enough that Darren's condition had stabilised sufficiently for him to be brought to the Education/Vocational Centre.
!Education/Vocational Centre Attendance: Phase One
(See [[1. Educational-Vocational Engagement and Assessment]])
During the first two-week assessment period the following key observations were gathered:
*Educational Assessment
Darren was initially very reluctant to participate in any areas of the educational programme. However once he did start to engage it was possible to carry out a reading test which showed that he had a reading age of 9.5. This clearly showed why he would have difficulties accessing the secondary school curriculum. Further testing showed that he had some word recognition difficulties consistent with a mild form of dyslexia. His numeracy skills were average for his age. He talked about his liking for drama but mainly focused on his ambition to be a professional drummer.
*Social Assessment
At first he would only stay in the Education/Vocational Centre if the KW promised to stay with him. He would not join in any activities at all for the first three days but stayed on the fringes covertly observing what was going on. He was surly but not aggressive in his manner towards the staff. He kept his hood up during this phase.
In the break periods he was gradually encouraged to talk by one of the other young people in the group. After day four he slowly started to participate in the education programme. Once his hood came down it became increasingly easy to sustain a conversation with him for short periods.
He could not be taught in a group with anyone else because he would "wind up" others to the point that violence would either happen or be threatened.
After initial reluctance he would agree to be taught one-to-one and would be relatively co-operative. He would quickly become discouraged if he could not be successful with a piece of work straight away and would frequently tear something up if it was less than perfect in his eyes.
*Family Assessment
The KW persuaded Darren's mother to attend some of the multi family group meetings. She was consistently critical of him and blamed him for all the trouble that he had caused the family. Darren became totally withdrawn and silent during these meetings. His younger brother came to one meeting. He was also critical of Darren and complained about how embarrassed he felt about having an older brother who showed him up at school.
In the individual family meetings which were attended by all the family including Darren's father, it appeared that Darren's breakdown or illness had had the effect of bringing together what had formerly been a fairly disconnected family. Harshness, criticism and mutual blame characterised the family communication patterns.
*Individual Assessment
Darren engaged well with his individual therapy and talked about his feelings of being a failure and about his anger towards everybody in his family. He said that he had felt suicidal in the past but currently had no such thoughts. He said that he wanted to get his life together and make a career for himself as a drummer.
!Education/Vocational Centre Attendance: Phase Two
(See [[2. Educational-Vocational Intervention and Transition]])
A literacy programme was devised to specifically help Darren with his reading difficulties.
Through connections with the school SENCO curriculum relevant to his GCSE subjects was brought to the Education/Vocational Centre for Darren to do. He was helped to organise himself so that he would be able to take four of the GCSEs that it was still possible for him to enter. The SENCO also arranged for him to slowly reintegrate into the school first of all via the drama lessons but with a plan to increase as his confidence and self esteem improved.
In the [[MultiFamilyWork]] meetings other members of the group started to challenge Darren's mother about the amount of criticism that she aimed in his direction. She began to talk about her feelings of guilt and frustration and how she had felt unable to help Darren. She had always known he had more problems with his schoolwork than his brother but hadn't been able to get anybody to offer any help.
She and Darren created targets for each other; significantly, she would try to be less critical and he would try to stop winding up his brother.
In YP group meetings the others in the programme were able to see behind Darren's "loner presentation" and were able to help him to face up to his avoidance behaviour as well as supporting him in his feelings of anger about his family's lack of understanding and support.
Peer group relationships around the Education/Vocational Centre improved significantly as Darren reduced his winding up behaviour towards others.
The family meetings also focused on the negative ways that everybody related to each other. Cross-generational patterns were relevant for both Darren's mother and father. Strains in the marital relationship were discussed in separate couple sessions. Darren and his brother were able to resolve some of their jealousies and rivalries to a limited extent.
In his individual sessions Darren switched between more pragmatic work in relation to his fears about drug and alcohol misuse and deeper issues related to his feelings of hopelessness and inadequacy.
Through links with the youth theatre leaders, Darren was encouraged to take up drumming lessons with a local musician.
At the end of the three months he had returned to school part time, was not misusing alcohol or cannabis and reported that he had not heard any voices since soon after the initial crisis.

!description
A style of opposition, noncompliance, and/or refusal to follow directives from authority figures (parents, teachers, social workers, police, etc); some degree of defiance is normally expected, and behaviour should be rated as problematic only if it deviates from age and cultural norms.
!end of description
!breakdown
0 = No problem. Occasional non-compliance, but usually responds to requests when limits and rules are clear.<br>
1 = Mild. Often ignores or argues with adult requests, but will usually comply after repeated demands and limits.<br>
2 = Moderate. Ignores or refuses to comply with adult requests often (e.g. half the time);often requires threats of punishment and ultimatums to comply.<br>
3 = Severe. Most of the time that requests or demands are made refuses and engages in a battle of wills; defiance is present in more than one setting or relationship.<br>
4 = Very severe. Most interactions with adults are characterized by opposition, defiance, and conflict, leading to major behavioural, academic, and social problems, and interfering with social and cognitive development.
!end of breakdown

!description
Refers to deliberate destruction of the young person's own or other people's property, whether in rage episodes or not, such as graffiti, breaking windows, throwing things, etc.
!end of description
!breakdown
0 = No problems - no destruction of property in any reports.<br>
1 = Mild . Occasional mild destruction of property e.g. throws own possessions when angry, draws on walls.<br>
2 = Moderate. Significant destructive behaviour either affecting many of his/her own possessions or deliberately breaking others' possessions more than once e.g. punches holes in wall, rips books.<br>
3 = Severe. Major repeated destructive behaviour e.g. rips up clothes, breaks parents' possessions.<br>
4 = Very severe. Destructive behaviour that has serious consequences for the family or community e.g. fire setting that causes property damage, repeated out of control rages where young person smashes and throws objects.
!end of breakdown

!description
Aggressive and/or sadistic behaviour that could or does result in harm to other people or animals; socially or culturally sanctioned forms of aggression (e.g. hunting, killing insects) are not considered, unless they are conducted in an unusually sadistic manner (e.g. taking pleasure in pulling the wings off butterflies). Use the Risk Assessment and Care Plan if this scores >1.
!end of description
!breakdown
0 = No problem - has not precipitated any physical conflict with others.<br>
1 = Mild Gets into physical fights with others more frequently than is typical for his/her peer group.<br>
2 = Moderate. Aggressive or belligerent frequently (several times per week), or shows severe aggression, so that injury is likely, or shows overt physical aggression toward an adult, or cruelty to animals that does not result in major injury but is intentional.<br>
3 = Severe. Repeatedly so aggressive that others are injured (e.g. bloody nose, black eye), cannot be contained by normal limits and structures, is seen as a danger to others, or has intentionally seriously injured or killed an animal.<br>
4 = Very severe. Has seriously injured another person (e.g. broken bones, required medical attention) and continues to be out of control so that further incidents are likely; or, repeated deliberate killing of animals; or sadistic behaviour in which overtly enjoys causing pain.
!end of breakdown

!description
Rate preoccupations, anxieties and behaviours that cause distress, conflict, or risk to the young person or others. These may include acting out, such as promiscuity, abuse, or exhibitionism, or inhibitions, such as obsessive worrying about sexual matters or anxieties that inhibit social interactions. Gender identity issues are not rated here unless accompanied by problematic sexual anxieties or behaviours. Use the Risk Assessment and Care Plan if this scores >1
!end of description
!breakdown
0 = No problems - no concerns reported from young person or others.<br>
1 = Mild. Disturbing worries or doubts regarding sexual issues, repeated inappropriate sexual comments.<br>
2 = Moderate. Sexual issues cause significant distress and/or social problems, for example, anxieties or obsessions with sexuality interfere with social relationships, public masturbation, inappropriate sex play with peers.<br>
3 = Severe. Sexual behaviour which creates social or physical risks, e.g. promiscuous unprotected sex, exhibitionism.<br>
4 = Very severe. Extremely inappropriate sexual behaviour, such as rape, molestation with coercion.
!end of breakdown

!description
Presence of psychotic symptoms, such as Delusions (firmly held false beliefs held without objective evidence, often impossible or highly improbable. Delusions are not affected by rational argument or evidence to the contrary, and are not a conventional belief in the context of the person's social or cultural background) or Hallucinations (any experience of objectively unrealistic perceptions, such as hearing, seeing, hallucinations of touch or smelling things that others do not, when NOT under the influence of intoxicating substances. Rate descriptively only, not based on presumed cause. Rate flashbacks only if they are experienced as real, rather than as intense memory.)
!end of description
!breakdown
0 = No problems involving psychotic symptoms. Distortions and misperceptions just before or after sleep that are not persistent or repeatedly disturbing are counted as normal.<br>
1 = Mild. Circumscribed delusions that do not affect daily behaviour, e.g. believes that dead grandmother is actually alive, in spite of having attended the funeral and many attempts to convince otherwise. Repeatedly distorts perceptions in ways that cause or fuel anxiety, e.g. sees frightening figures at dusk, interprets sounds as voices.<br>
2 = Moderate. Delusional beliefs affect behaviour, but impact is confined to a specific arena e.g. believes she may contract syphilis from eating utensils, and will only use disposable tableware. Persistently claims to hear or see things others cannot, e.g. flashbacks to traumatic experiences, but does not react or respond to hallucinations.<br>
3 = Severe. Delusional beliefs play a major role in daily behaviour, influencing behaviour, attitudes, and communication e.g. believes is the son of God and talks about this constantly to peers and adults. Can be observed to be responding to apparent hallucinations, which interfere with normal functioning.<br>
4 = Very severe. Behaviour dominated by response to delusional beliefs, e.g. cannot leave own room for fear of persecution by enemies. Vivid apparent hallucinations that cause distress, or issue destructive commands (e.g. suicidal or homicidal).
!end of breakdown

!description
Mood which is unusually 'high', 'giddy', manic, unrealistically happy, out of proportion to real events. Irritability associated with manic states is rated separately.
!end of description
!breakdown
0 = No problem. Normal range of mood; may be giddy/silly at times, but settles down age-appropriately in a serious situation.<br>
1 = Mild. Often silly or giddy, and has trouble settling down in serious setting.<br>
2 = Moderate. Seems markedly 'high', unrealistically optimistic, hard to focus on realistic plans and goals; this interferes with functioning in some areas.<br>
3 = Severe. Elated mood clearly interferes with functioning (e.g. stays up late at night working on projects and cannot stop, makes grandiose plans).<br>
4 = Very severe. Elated mood dominates behaviour and severely disrupts judgment and functioning (e.g. wildly excessive ideas and plans, racing thoughts, promiscuity, dramatic overspending, does not sleep for several days).
!end of breakdown

!description
The capacity the young person has to show sensitive recognition of other people's changing mental states and the effect these have upon their actions, or to reflect thoughtfully upon affective states of their own. When present, the young person demonstrates 'mind-mindedness', but when absent there may be callous, unemotional traits or an incapacity to tolerate frustration and affective states without resorting to defensive or displacement activities.
!end of description
!breakdown
0 = No problem. Shows mentalizing capacity appropriate to age - generally reflective, sensitive and tolerates frustrations - it is normal for mentalizing capacity to diminish at times of high affect or conflict.<br>
1 = Mild. Occasional lapses in capacity, when young person 'misreads' people in ways that stand out, but can generally 'correct' such errors.<br>
2 = Moderate. Frequently misreads people, or appears to react without sensitivity to the people around him/her.<br>
3 = Severe. Major difficulty in empathising with people, frequently overwhelmed by situations, struggles to reflect on what makes people act the way they do, or to manage emotional states without "acting out", etc.<br>
4 = Very severe. May appear callous or unemotional, assume that own thoughts actually represent reality rather than representations of reality, frequently acts-out, chronic failure of confiding relationships.<br>
!end of breakdown

!description
The extent to which the young person is successfully engaged in the development and carrying out of his or her treatment and care.
!end of description
!breakdown
0 = Good. Fully involved in assessment, planning and implementation of care. Works towards realistic personal goals; co-operative with procedures and assessments.<br>
1 = Mild. With support involved in assessment, planning and implementation of care at a level appropriate to age, but some reluctance/resistance to comply with care plan. Co-operative in most but not all areas. <br>
2 = Moderate. Significant difficulties in engaging with treatment plan and/or formulating realistic age-appropriate goals. <br>
3 = Severe. Refusal to engage or passive compliance with many aspects of care. Cannot agree realistic age-appropriate goals.<br>
4 = Very severe. Will not comply with most aspects of treatment/care plan. Refuses to/unable to engage in age-appropriate discussion of goals.
!end of breakdown

!description
The length of time the young person has experienced significant behavioural or emotional problems (not limited to the presenting problem)
!end of description
!breakdown
0 = No significant problems.<br>
1 = Problems present for less than one month.<br>
2 = Problems present for one month to six months.<br>
3 = Problems present for six months to four years.<br>
4 = Problems present for more than four years.
!end of breakdown

A conversation about AMBIT-influenced approaches to working with young people who offend. Some keys thoughts emerging from this conversation:
*Remembering to "peel the banana" - What you see (the offending behaviour) is just the skin but what's underneath?
**how did young person get into this situation? What created the context where this behaviour made sense?
***remembering importance of trauma
**offender as victim
**grooming
**repeating experiences of being "let down" - a cycle: feeling let down -> offending -> response to offending -> feeling let down
*Encouraging young people to mz the victim? But, //first//, self
*mentalizing and gangs
**gangs as anxiety-infused systems
**risk of "us and them" thinking leading to dis-integration
**identifying the key figures in the system with whom to hold [[Connecting Conversations]]
**systemic interventions, helping gangs to make sense of - and navigate - helping services
**good ability to develop epistemic trust

!description
The extent to which the major problems the young person presents are evident in multiple settings or domains of functioning e.g. family, education, psychological, physical, social-environmental.
!end of description
!breakdown
0 = No significant problems.<br>
1 =Occasional problems, confined to one setting or domain of functioning e.g. argues with parents about once a week, or anxious at school exams.<br>
2 =Regular problems in one setting or domain e.g. behaviour problems at home with parents and caretakers, but not at school, or conflicts at school and over homework at home, but not in other areas at home, or aggressive outbursts occur in the household of one parent, but not the other.<br>
3 =Problems are present in more than one setting/domain e.g. anxiety affects schoolwork and relationships with peers, defiance is present at home and school, young person is defiant with mother and anxious at school.<br>
4 =Problems are present in all or almost all settings and domains e.g. failing in school, depressed at home, isolated with peers.
!end of breakdown

Participants offered some favourite definitions of mentalizing:
*Seeing situations from another person's perspective
*understanding BEHAVIOUR - and the function of it - that of others and of ourselves
*seeing life through someone else's eyes - in order to understand behaviour
Then, participants shared some language they use to promote mentalizing in others:
*"What might it be like for your mum seeing you like this?"
*"If you were a fly on the wall/an alien/an outsider what you think/say about this?"
*Mirroring
*Modelling mentalizing - sharing our thoughts, sharing the experiences of others, pair work (modelling mentalizing conversations in the room), canine work
Thoughts on how to create the conditions for a young person to get their mentalizing going:
*change environment
*Wait until affect lowered before attempting. Time out. Choose your moments - you might want to have the conversation now, but it is going to be better in the long run to wait until a time when the young person is in a mental state
*Change subject - to lower affect (have a contract in advance about managing this. Agreement about use of humour)
*sensitive attunement - giving the experience of being mentalized -> epistemic trust

"bold"AMBIT was introduced in Camden in 2013 in order to provide a shared framework for work with families with acute and complex needs who have multiple Camden services involved in their lives.
The aim is to offer well co-ordinated interventions that are guided by a comprehensive [[Formulation]] of a family's resilience factors and risk factors which takes into account of [[Transgenerational Patterns]].
All work undertaken with the family will have clear objectives.
We are developing an [[Integrated Family Framework]] which draws on some core principles:
-[[Team Around the Worker]]
The approach follows a flexibile pattern of steps;
-[[Identification of families for IFF approach]]
-[[Preparation of Initial Family Interview and Consent]] to decide how TT should start engagment process including informing network about IFF {Jim, Dee, Caitriona by 11.10.13}
-[[Initial Family Interview and Consent]]{Jim, Dee, Caitriona by 11.10.13}
-[[Allocation of Primary Worker]] Lola & Thomas 08.11.13
-[[Network submit their case summaries to Primary Worker and TT]]{Paul, Thomas by 18.10.13}
-[[Primary Worker]], TT worker and [[Clinical Lead]] prepare [[Formulation]] using at least on [[Small Group Discussion]]. The formulation is documented on the [[Core Family Record]]{Nick, Lola, Trini by 11.10.13}.
-[[Professionals' Forum]] convened to share analysis. This may involve different tools such as [[Fish bowl]], [[Disintegration Grid]], [[Network Sculpt]] technique chaired by [[Clinical Lead]]{Nick, Thomas by 04.10.13}
-[[Implentation of IFF intervention plan]]{Katie*, Caitriona, Dee, Mel, Janet, Aurora, Lisa*- first outline draft by 25.10.13}
-[[On-going review]], [[Intervention Evaluation]]{Katie, Dee*, Veronica, Thomas*, Mel, Aurora, Dameshk- outline proposal by 18.10.13}
*Denotes the lead for the different steps. Their responsiblity is to bring group together, map out a plan and allocate work to members of the group.
You can catch up on the team's AMBIT trainings by checking the [[Camden TT training log]].
[[Practical Camden Examples]] of how AMBIT has helped to inform practice across Camden services are being made available.

This is a common example of a [[Training Challenge]] (a less off-putting term for 'homework') set in a [[Cognitive Behavioural]] approach.
''THE PURPOSE OF DIARY KEEPING IN CBT''
Sometimes diary keeping is carried out without being clear what the purpose of diary keeping is. As an approach CBT is concerned with trying to enable the young person to make changes in their daily life and is less focussed on changes that take place in the therapy itself. Diary keeping is a method of trying to connect the therapy sessions with real events in the young person's life. One of the ways that the young person's life is kept at a distance from the therapy is by the young person providng vague, general statements about themselves and the events of their week. For example atypical enquiry can go as follows. 'How are you?' 'Okay'. 'How has your week been? 'Okay'. 'Been out much?' 'A bit' 'Had any good days?' 'Not sure'. etc Such general evaluative statemetns are of little value in CBT. It can be similar when the statements are negative e.g 'How has your week been?' 'Shit'. The purpose of diary keeping is rarely to obtain a comprehensive picture of the whole week's events but more to locate one specific event that can then be explored in more detail as a way of getting these general statements.
Most young people find keeping a diary record of what happens during the week very hard to do. Do not be discouraged by this but be extremely practical about how to encourage young person to begin to keep very simple records of what has happened in between sessions.
''Start with a simple frequency diary''. This simply asks the young person to notice whether a certain thing happneded on a particular day. For example, having a row with a parent. Getting the young person to notice if this happened each day. In practice, at the following session, the young person may turn up without any record etc and you may need to go through the week asking for each day. What may be very helpful is to get interested in the days that NO ROWS took place.
Nowadays, young people can ''use mobile phones'' or other IT equipment to keep records of things. For some young people I have suggested they write a quick text message to themselves as a reminder of something that happened. There may be circumstances that it is appropriate to have an arrangement for the young person to text the therapist as a record keeping task. This can be excellent but needs to be set up with very clear task boundaries so that young people do not expect a therapist response to all such messages.
if you have suggested a diary task, it is ''CRUCIAL'' that you are very interested in what the young person has done around this at the following session. If you minimise or forget, you model the very behaviour which you are trying to change.
If the young person is able to do some frequency diary work, it may be possible to move on to doing more complex diary work using an ABC format (see below). This allows for a close analysis of the possible [[Reinforcement]] of particular behvaiours, and the design of new [[Contingencies]] that might help to //reduce// the reinforcement of undesired behaviours, and //increase// the reinforcement of desired behaviours. The purpose of this is twofold. Firstly, it may provide some ideas about how negative behaviours are being encouraged by their consequences. Secondly, it may help the young person to see 'patterns of interactions' rather than just being dominated by own feelings and thoughts.
*Ask the young person to keep a diary sheet, either simply recording daily drug/alcohol consumption (or any other behaviour that is targetted, such as self-injury) or, preferably, (as it gathers more information to work with) recording ''__A, B, C__'';
!A = Antecedents
What came ''just before'' the target behaviour (e.g. smoking the joint/the aggressive outburst/etc) - //"Where were you? Who else was there? What were you thinking? What do you remember feeling?/etc."// (It is easy to see that thinking about these things is getting close to [[Mentalizing]].)
!B = Behaviours
What ''actually happened''? (e.g. smoked 1, 2, 3 joints...)
!C = Consequences
What happened ''afterwards?'' Think of short term effects (fun? paranoia? fights? Police?) and longer term effects (parental arguments, trouble at school...) - see [[Weighing Pros and Cons]] for more ideas on this.

!This is a Team task
The [[Our Resources]] [[tag|Tags]] is intended to be a working collection of documents that individual teams adapt, to build a 'library' of useful resources for the work they are doing. These should be maintained as part of the TeamTemplate - part of the task of [[Manualization]], whcih is one of the [[Core Features of AMBIT]].
!To add new Resources:
When you are logged in as a Team editor you can click on the tag @@<<tag [[Our Resources]]>>@@ and then from the bottom of the drop down menu select "Create new tiddler with the same tag as this", which will generate a new tiddler ready to edit, but already-tagged as {{{[[Our Resources]]}}}". Alternatively, just place the word ''Resources'' in the [[Tags]] box in a new tiddler that you are editing.
!Existing Material:
*[[AMBIT Forms]] - offers downloadable copies of slides/paperwork that may have been used in AMBIT trainings, and which can be used by local teams.
*CrisisServices - a place to detail Crisis services operating in the local area. (You could create a range of separate tiddlers, each tagged with the phrase CrisisServices.)
*[[Local Protocols]] - where to record protocols that the local team has developed for specific tasks. (You could create a range of separate tiddlers, each tagged with the phrase "{{{[[Local Protocols]]}}}".)
*[[Team members]] - Here you can record the names and brief biogs of team members, and if you wish photos, too (see [[Adding IMAGES, DOCUMENTS or VIDEO clips]]).
*TeamContacts - here you could place telephone/fax numbers of services/offices frequently used by team members (note the warnings about privacy below, though, and only display numbers that are already in the public domain.)
!Suggested Locall resources to record:
>e.g. Youth clubs
>e.g. Sports Centres
>e.g. Special offers available for young people
>etc
!Warnings
!!!!Privacy
Be mindful of individuals' rights to privacy. Do not add addresses or telephone numbers unless these are resources that are already available on the internet. If in doubt, you can provide HyperLinks to existing web-based resources.
!"Resources" are not Strengths or Resiliencies
We define StrengthsResiliencies in a young person/family as something different from the Resources that a KeyWorker may be able to draw on. (If you are using the manual as an [[ICR]], StrengthsResiliencies for a client can be recorded under [[Make or View Client Notes]]).

Attention Deficit Hyperactivity Disorder
This is a neurodevelopmental disorder - the common core features of ADHD are:
*Attention problems (distractibility, difficulty staying on task)
*Impulsivity (the opposite of looking before you leap)
*Hyperactivity (high levels of physical energy and movement - "like a motor always on the go")
!Comorbidities
ADHD is associated with a wide range of other difficulties (co-morbidities), including:
* [[Conduct problems]]
* Educational under-achievement
* Disorganisation
* Low self esteem
* [[SubstanceUseDisorder]]
* Family dysfunction
In adolescence (as opposed to younger childhood) it is not uncommon that the main difficulties expienced are related less to the "core deficits" (Attention, Activity, Impulse control) and more to the "satellite problems" that arise as co-morbidities.
!Treatment
Prescribing medication is the mainstay of treatment at earlier ages, alongside work with the family, school, and young person to help manage behaviours and associated mood problems. Treatment may take the form of ''controlled drugs'' such as methylphenidate (a "Stimulant" drug, that seems to preferentially stimulate the frontal area of the brain, boosting the "executive" part of the brain that controls decision-making, and reduces impulsivity. This treatment may be difficult at older ages. This is particularly so if it is those co-morbidities that are now the main problem, and in general starting treatment late is much less effective than starting it earlier in the life course, with a view to helping establish good peer and family relations, improved school performance, and better self esteem.
If [[SubstanceUseDisorder]] is a problem this makes use of the "stimulant" medications such as methylphenidate even more difficult, because of perceived risks of misuse of this medication (slow release preparations do reduce this risk, and there are non-stimulant alternatives, but these are still often insufficient to impact on other patterned behaviours that have begun to become ingrained.)
There are well researched and evidenced protocols for managing ADHD, in the UK these are provided in the [[NICE ADHD Guidelines]]

!Purpose
Explain what the AIM is, and how to use it.
!What is it?
AMBIT AIM stands for ''AMBIT Adolescent Integrative Measure''.
The questions in the AIM have been adapted by DickonBevington and PeterFuggle from the Hampstead Child Adaptation Measure (H-CAMA), which was originally authored by PeterFonagy and MaryTarget.
The AIM is a multilevel/multidimensional assessment, taking in psychiatric symptoms, social ecology, relationship networks/qualities, and resiliencies. It is available for use in this TiddlyManual for [[AMBIT]], and is part of what the AMBIT team recommends as a [[Multi-Domain Assessment]].
It can be used independently of AMBIT (it is currently one of the measures in use for the large IMPACT study of adolescent depression.)
!How to use it
The form where you can complete the AIM is at [[AIM Form]].
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When you are gathering the information required to complete the AIM, you will find the areas covered by the AIM all listed under: [[Topics covered by the AIM - a checklist]] .
Individual items are scored and each can be labelled as one of a small number (less than 6) of [[Key Problems]]. The assessment is designed to be completed by a practitioner, and can be completed over a period of time (2 weeks) in view of the extent of the areas that it covers.
There are numerical measures for each item, ranging from 0+ (a positive strength), through 0 (no problem), and up to 4 (very severe problem). Each item has its own descriptions of the levels of severity to help in scoring.
Each item also offers the opportunity to label it as one of a small number (say 6 or less) of [[Key Problems]], which is a helpful way to focus on the most pressing problems in a complex situation.
The version applied in a TiddlyManual has particular interactive properties with manualized content, which generates [[AIM suggested interventions]], according to the results of the assessment.
You can complete only part of an AIM (just a handful of items, or even just one item) and "suggested interventions" will still be generated. Good if you want a prompt without going into details around the complexity of a case.
!What next?
*[[AIM Form]] - This is where you can check boxes to record your assessment - what you type is ''NOT uploaded to the internet'', but at the end of the assessment you can click a button ("Export AIM" under the heading "AIM results") that creates a report that you can then file or export to a local database.
*[[AIM suggested interventions]] - These are found at the end of the [[AIM Form]] in the AIM Results section. Once completed, the AIM questionnaire finds and ranks suggested [[Specific interventions]], according to the needs defined in assessment profile given in the [[AIM Form]], and related to the available evidence base.
*[[Topics covered by the AIM - a checklist]] - A short checklist of the major topics covered - print it out as a prompt to ensure you cover the right areas as you gather the NARRATIVE ACCOUNT of the history of the problems in your [[Multi-Domain Assessment]].

We advise that using the version of the manual that is embedded in the manual is more helpful - as the results are integrated and interactive with other material in the manual. Use a downloaded version of the manual (see [[ICR]]), or if you are NOT logged in (nothing will save) with editorial rights you can use the online version directly (so log as you are not logged in with edit rights, nothing will be saved online).
If you prefer to have a paper version - here it is. You will see it is stored at "Google Docs" and can be downloaded [[here|https://docs.google.com/open?id=0B5h_CVBdhJPYck41Y2p5d0g0N3c]]:
----
<html><iframe src="https://docs.google.com/file/d/0B5h_CVBdhJPYck41Y2p5d0g0N3c/preview" width="640" height="480"></iframe></html>

!This is content from AMASS!
>//This is an example of a page that has been [[cloned and customised|Clone and Customise]] from the original work by the AMASS team in Islington - to whom we are immensely grateful.//
We have been trialling the use of the cards which have been adapted from the [[AIM]] as an assessment tool as part of the direct work/outreach work with the young person.
We would like these cards to become part of our assessment process within the [[AMASS Intervention Timeline]] and have started to integrate this into the core process for every young person working with AMASS.
Our Assistant Psychologist has identified a potential framework for incorporating it as a collaborative assessment tool and an outcome measure. It uses the Focal Ranking system followed by the Global Ranking system (please see [[AIM suggested interventions]]).
!!!!!Suggested Framework:
* Have AIM card session in week 6. This enables parallel of ratings weeks and parent work (completion of [[Genogram]], [[End Goals]], [[Desired Changes]]) but also means time has been invested into developing trust between young person and worker.
* Explain to young person that these cards are strengths/challenges/difficulties that young people face as part of growing up. The session is aimed at trying to identify what particular strengths/challenges/difficulties are most relevant to them.
*See video produced by the AMASS team in Islington (@ambit-amass) showing how the cards can be used in a session with a young person:
<html><iframe width="420" height="315" src="//www.youtube.com/embed/wG9Of1PCHPI" frameborder="0" allowfullscreen></iframe></html>
!!!!!Incorporation of Outcomes:
*A follow up session can reflect on what three/four cards the young person chose and this allows the worker and the young person to collaboratively discuss how to focus on these cards.
*The young person can rate the severity of the problem indicated on the card, how much it affects them using the numbers on the card.
*At the end of the intervention the AIM card session can be repeated and the ratings of the three/four cards can be compared from the pre-intervention AIM card session.
*Ratings can also be taken more frequently within the intervention and the ratings profile can be plotted on a graph which can be shared and reflected on with the young person at the rating points and/or the end of intervention.
!!!!!Helpful Hints:
*BE FLEXIBLE: The framework can be adapted according to what suits the young person - (i.e. some young people may need to be doing another activity whilst the worker reads the cards and puts them in piles according to what the young person wants or the way in which the ranking happens may change according to young person's choice).
*LISTEN: The session allows an exploration of what the young person feels about themselves and any challenges/difficulties they are facing. You can explore and ask questions about what the young person talks brings to the session.
*COLLABORATION: The cards enable a [[Thinking Together]] process with the young person to plan for future sessions together and for the young person to feel part of the intervention/outreach process.

!What does this license apply to?
This license applies to all written material relating to the [[AIM]] questionnaire which remains the copyright of the [[Authors of the AIM]].
!!!!If you're reading this in the AIM's ''__//own website//__''...
(E.g. in @ambit-aim or at the address {{{http://ambit-aim.tiddlyspace.com/}}}) ...then it applies to everything except the technical material about @tiddlywiki and @tiddlyspace which is licensed separately (and more openly, see at the bottom of the page.)
!!!!If you're reading this in ''__//another wiki//__''
(E.g. in which the AIM questionnaire has been embedded or "included") ...then this license __only relates to material connected with the AIM__ (the content in whatever other wiki this has been embedded in may be licensed separately!)
Complicated, but simpler than it sounds...
!Released under license:
<html><a rel="license" href="http://creativecommons.org/licenses/by-nc-sa/3.0/"><img alt="Creative Commons License" style="border-width:0" src="http://i.creativecommons.org/l/by-nc-sa/3.0/88x31.png" /></a><br /><span xmlns:dct="http://purl.org/dc/terms/" href="http://purl.org/dc/dcmitype/InteractiveResource" property="dct:title" rel="dct:type">AMBIT AIM - Adolescent Integrative Measure</span> by <a xmlns:cc="http://creativecommons.org/ns#" href="http://ambit-aim.tiddlyspace.com" property="cc:attributionName" rel="cc:attributionURL">Schneider, Fonagy, Target, Bevington, Fuggle</a> is licensed under a <a rel="license" href="http://creativecommons.org/licenses/by-nc-sa/3.0/">Creative Commons Attribution-NonCommercial-ShareAlike 3.0 Unported License</a>.<br />Permissions beyond the scope of this license may be available at <a xmlns:cc="http://creativecommons.org/ns#" href="http://annafreud.org" rel="cc:morePermissions">http://annafreud.org</a></html>.
!Summary of terms:
''You are free:''
* to Share — to copy, distribute and transmit the work
* to Remix — to adapt the work
''Under the following conditions:''
* ''Attribution'' — You must attribute the work in the manner specified by the author or licensor (but not in any way that suggests that they endorse you or your use of the work).
* ''Noncommercial'' — You may not use this work for commercial purposes.
* ''Share Alike'' — If you alter, transform, or build upon this work, you may distribute the resulting work only under the same or similar license to this one.
''With the understanding that:''
* ''Waiver'' — Any of the above conditions can be waived if you get permission from the copyright holder.
* ''Public Domain'' — Where the work or any of its elements is in the public domain under applicable law, that status is in no way affected by the license.
* ''Other Rights'' — In no way are any of the following rights affected by the license:
** Your fair dealing or fair use rights, or other applicable copyright exceptions and limitations;
** The author's moral rights;
** Rights other persons may have either in the work itself or in how the work is used, such as publicity or privacy rights.
''Notice'' — For any reuse or distribution, you must make clear to others the license terms of this work. The best way to do this is with a link to the Creative Commons webpage defining this licence, [[here|http://creativecommons.org/licenses/by-nc-sa/3.0/]].
!@@color(red):Software licensed separately@@
The software in which the AIM is recorded ([[TiddlyWiki]] and [[TiddlySpace]]) is a freely available 'Open Source' development, licensed separately under slightly different (more open) terms. We gratefully acknowledge that its modification for this manual has been kindly supported in a non-commercial open-source collaboration by its inventor Jeremy Ruston and his colleagues (particularly Jonathon Lister) at [[BT Osmosoft|http://www.osmosoft.com/]].

<<AIMForm AIMFormViewTemplate AIM>>

Change this number below (keep "limit:") to alter the allowed maximum number of selected Key Problems on the AIM form.
limit:6

!Introduction
Many of the young people AMBIT is designed for have high levels of [[Complexity]] and [[Comorbidities]]. It can be difficult to decide [[which intervention|WhichInterventionWhen]] to use, when, and the AMBIT [[AIM]] assessment can help you in this task by analysing your results and generating suggested interventions in the form of ranked lists, which provide direct [[Links]] to the manualized interventions.
!How does it work?
At the end of the [[AIM Form]] you will see a final page titled ''AIM Results''. At the bottom of that page you will see the ''Suggested Interventions'' section.
The AIM questionnaire collects the severity scores you have entered across the 40 items in the questionnaire for your client, and then uses quite simple algorithms to rank potentially useful (evidence-based) interventions for the problems you have identified with your client. These algorithms are explained below.
The fact that //''different lists''// of suggested interventions are generated is in itself designed to communicate to the KeyWorker that, because the lives and difficulties of young people we work with a generally marked by COMPLEXITY, ''there is NOT a simple mechanical relationship between "problem //a//" and "intervention //x//"''
Thus the KeyWorker is encouraged to use these lists as an additional layer of 'mentalized' oversight on a case; one that offers a more or less objective //perspective// on the options open to him or her, or to discuss them in [[supervision|SupervisoryStructures]] The lists should be used to monitor whether or not what is being delivered is broadly in line with other thinking, and to stimulate questions if there is wide variance between what is suggested and what is actually being offered:
>''//"Am I offering my 'favourite' interventions, rather than the ones most suited to the needs of this person at this time and place?"//''
See also WhichInterventionWhen for other advice on how to sequence what to do, or [[I'm stuck: what next?]] if you are at a more general impasse.
!How does it rank interventions?
In order to make it quite clear that this is not a "check-box" exercise, and that there must be flexibility for the worker in deciding what to do, there are different ways to sort these suggestions, depending on whether you want to look at addressing the whole spread of a young person's difficulties (''GLOBAL ranking''), or to focus on the most severe ones first (''FOCAL ranking''), and whether you want to limit your attention just to the [[KeyProblems]].
* ''GLOBAL RANKING'' - each suggested intervention is ranked according to //how many different problems// (that is, AIM items scoring greater than 2) the young person has //which that particular intervention has evidence for being effective in treating//. This is good for selecting interventions that will COVER THE WIDER SET OF PROBLEMS AND THEIR CAUSES, in particular for finding approaches that might address some of the [[Comorbidities]] that frequently act as //maintaining factors// for the young person's difficulties.
* ''FOCAL RANKING'' - each suggested intervention is ranked in order of how SEVERE the set of problems it has evidence for being effective in treating are (their averaged AIM scores). This is good for FOCUSING THE MOST EFFECTIVE INTERVENTIONS ON HELPING WITH THE MOST SEVERE PROBLEMS.
* ''LIMIT'', as the title suggests, this limits the suggested interventions that are ranked in both of the above sorting algorithms //only to those relevant for items identified as KEY PROBLEMS//.

!Welcome to the AIM
This is an interactive assessment (your results generate relevant links to material in the manual), that can be filled in on your computer and then the results can be exported and saved.
!!Learn
There are instructions below, or watch videos. See [[AIM]] for more description.
A short rather low-fi clip demonstrating the AIM questionnaire in the AMBIT manual:
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This video, from an AMBIT Train the Trainer training, describes the [[AIM Cards]] first (a self-report version), but discusses the AMBIT AIM and demonstrates it from 8min:45sec:
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!!Confidentiality
''ALTHOUGH THE ASSESSMENT IS CONDUCTED IN YOUR WEB BROWSER, YOUR ANSWERS TO THE AIM QUESTIONS DO NOT LEAVE YOUR LOCAL COMPUTER'' (this is because the whole website is effectively downloaded and runs from within your local computer when you open the site.)
|bgcolor(pink):''As additional (non-mandatory) precautions (a) You may wish to check that you are NOT in the "Edit mode" (see explanation of how to do this this [[here|Edit mode]]) and (b) Do NOT use an identifiable NAME for the Unique ID''|
A 'paper' version of the AIM is also available to download [[Here|https://docs.google.com/Doc?docid=0AZh_CVBdhJPYZDZoMmdiNF80OTRnaHIzdDdnNA&hl=en_GB]].
You can see [[Topics covered by the AIM - a checklist]] to help guide the assessment interview.
!What to do:
!! Please fill in these details:
|Unique ID (//not// name): |<<option txtAIM_ID>> |
|Date of assessment: |<<option txtAIM_date>> |
|Name of assessor: |<<option txtAIM_assessor>> |
#The PRACTITIONER SCORES this questionnaire, not the young person, though it can be done collaboratively. (''NOTE:'' A self-report version presented as playing cards ([[AIM Cards]]) for use by a young person and their keyworker is under development.)
##During the initial assessment, score all 40 items.
##You may need to go back to the young person to gather more information.
##Aim to complete this within one week of first contact.
#"KEY PROBLEMS": These are limited to a maximum of SIX - this may require careful consideration.
##Key problems are those that appear to be the most important TARGETS for intervention.
##They can act as your [[Goals-based outcome measures]].
##These are things that the young person and family should help you identify. Ultimately it is the practitioner's decision (a young person with psychosis may not agree that this is the case, for instance - which does not mean that treating this is not an important treatment goal to measure your outcomes against.)
#ONCE COMPLETED:
##At the end of this form (see "AIM Results") there are instructions on how to:
###Export the results to a database
###List and rank [[AIM suggested interventions]] according to the results of the specific AIM assessment. These are useful, in addition to your SupervisoryStructures, to help you develop your [[Care Plan]], or as a problem/solution-focused pathway into the manual. This function only works if your AIM is embedded in a treatment manual, not if you are accessing the AIM site as a separate resource.
#Use for OUTCOMES
##When you start a specific intervention directed at a specific problem, use the relevant item(s) on the AIM to measure progress with the problem(s).
##When you end a complete treatment episode, re-score the KEY PROBLEMS to act as [[Goals-based outcome measures]].

Well done! You have completed the AIM, now...
!!1. Save and date this set of AIM results
Clicking on the "Export AIM" button, just below. There are instructions on how to [[Get AIM data into a spreadsheet]]:
<<exportAIM>>
!!2. Sort and rank suggested interventions
If you are using the AIM embedded within a treatment manual (such as AMBIT) then at the bottom of this page you will find the [[AIM suggested interventions]] function, which helps you to sort and rank suggested interventions in different ways, relating directly to your client's AIM scores. This works if you complete and ENTIRE AIM assessment, or even if you only answer a handful of questions (or just one!) so it is a good way to get prompts for //what interventions does this young person need// rather than //"what interventions do I like doing"//. If you are using the AIM as a standalone assessment (outside of it being embedded in a treatment TiddlyManual), then this is not available.
Many of the young people AMBIT is designed for have high levels of [[Complexity]] and [[Comorbidities]]. The AMBIT [[AIM]] assessment can help you sort and rank potentially useful interventions for problems identified. See also WhichInterventionWhen for other advice on how to sequence what to do, or [[I'm stuck: what next?]] if you are at a more general impasse.
!!!NOT a mechanical "tick box" operation!
There are different ways to sort these suggestions, depending on whether you want to look at the whole spread of a young person's difficulties (''GLOBAL ranking''), or to focus on the most severe ones (''FOCAL ranking''), and whether you want to limit your attention just to the [[KeyProblems]]. There is more explanation of this at [[AIM suggested interventions]].
<<AIMResults tag:'AIM' type:'weighted'>>

You have selected more than six key problems, which is not allowed. Please go back and remove some if you want this to be a key problem.

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!What does AMBIT mean?
|bgcolor(pink): ''__AMBIT__'' ///ˈæmbɪt/// <br>''Noun.''<br>a. Scope or extent<br>b. Limits, boundary, or circumference<br>c. ''A sphere of action, expression, or influence''<br><br>''__Etymology:__'' <br>16th Century: from Latin //ambitus// a going round, from //ambīre// to go round, from //ambi-// + //īre// to go |
!AMBIT as a way of working?
The word AMBIT itself is increasingly preferred as opposed to its use as an acronym A.M.B.I.T. (''@@color(red):A@@dolescent @@color(red):M@@entalization-@@color(red):B@@ased @@color(red):I@@ntegrative @@color(red):T@@reatment'') as there are services beginning to use AMBIT that are not specifically directed at working with Adolescents now.
!From A.M.B.I.T. to AMBIT to ''ambit-''
Probably best of all is to refer to ''ambit-'' as this is the prefix that starts the address to the many local versions of the wiki treatment [[manuals|Manualization]] and emphasises that there is little of ambit- without the local expertise that adopts, adapts and helps itself to shape the onwards development through its own contribution of [[Outcomes]] from the work.
!Links to descriptions of AMBIT:
1. See [[AMBIT: an overview]], or learn about [[Mentalization]] and how this can act as an [[Integrative]] framework for work in a multi-modal, multi-agency context.
2. [[Core Features of AMBIT]] goes into more detail
3. The [[AMBIT Wheel]] provides a good reminder.
!Past versions...
As this model of practice has developed over the past years it has been through various name changes - since 2001 it has been known as both [[IMP]] and [[M-BIO]]!

The [[AMBIT project]] employs a number of Assistant Trainers, who are experienced practitioners currently working in [[AMBIT-influenced]] teams
If you are interested in becoming an Assistant Trainer please get in touch

!Intro
This is the basic five day training - which consists of four days of training, and one //self-organised// practice day that is held locally. The [[Anna Freud National Centre for Children and Families]] provides [[AMBIT training]] for //whole teams rather than individuals//. See [[Training Testimonials]].
There are also <<tag [[Modified training plans]]>> for training trainers, etc.
|bgcolor(lightblue): There is [[Guidance for Teams Considering Applying for Training]]. |
We encourage ''as many people in a team as possible to attend the training days'' as this helps to create the local team culture that AMBIT is trying to support local teams to create for themselves.
|bgcolor(lightblue): ''Stage 1.0'' |bgcolor(lightblue):The five-step [[AMBIT Training Application Process]], taking note of the [[Guidance for Teams Considering Applying for Training]]:|
|bgcolor(pink): 1.1 |bgcolor(pink):Expression of interest|
|bgcolor(pink): 1.2 |bgcolor(pink):Engagement meeting|
|bgcolor(pink): 1.3 |bgcolor(pink):[[Pre-training team audit]]|
|bgcolor(pink): 1.4 |bgcolor(pink):Application review|
|bgcolor(pink): 1.5 |bgcolor(pink):''Acceptance''. Upon successful application (Stage 1), teams are invited to join:|
|bgcolor(lightblue): ''Stage 2.0'' |bgcolor(lightblue):[[AMBIT Basic Five Day Training]], developed to enable teams to get started with using an AMBIT-influenced approach. |
|bgcolor(pink): 2.1 |bgcolor(pink):[[AMBIT Basic Training Day 1]] - basic curriculum, whole team, external trainers |
|bgcolor(pink): 2.2 |bgcolor(pink):[[AMBIT Basic Training Day 2]] - basic curriculum, whole team, external trainers |
|bgcolor(pink): 2.3 |bgcolor(pink):[[AMBIT Basic Training Day 3 (AMBIT Leads)]] - smaller group working with trainers for a subgroup of "ambiteers" who will act as [[AMBIT Lead]]s; the core of the [[Implementation Team]]. |
|bgcolor(pink): 2.4 |bgcolor(pink):[[AMBIT Basic Training Day 4 (Local Practice Day)]] - Local learning/goalsetting, whole team (''LOCAL EVENT: no external trainers'') |
|bgcolor(pink): 2.5 |bgcolor(pink):[[AMBIT Basic Training Day 5 (Review and Consultation)]] - onwards learning, whole team . Ideally 2 - 3 months after initial days' training - creating a coherent local [[Implementation Plan]]. |
|bgcolor(lightblue): ''Other'' |bgcolor(lightblue):There are a number of <<tag [[Modified training plans]]>> for specific circumstances, and adaptation is "part of the model". |

!Learning Objectives for the day
The four main learning objectives for Day 1 are:
# [[Initial introductions at a Training event]] - 20 mins
# [[Developing Team Learning Objectives]] - I hr
# [[Learning about mentalizing|Training Exercises for Mentalization]] - 90 mins
# [[Learning about AMBIT]] - Brief overview and selected highlights in each of the four main quadrants of the [[AMBIT Wheel]] - afternoon.
!Possible timetable
* Please check for specific timings of your own training!
* AMBIT is about adaptation as well as structure, so variations are possible
!Day 1 - Didactic teaching and mini-exercises
!!1. Introductions and [[Developing Team Learning Objectives]] - I hr
To introduce individuals: [[Initial introductions at a Training event]]
Then:
(a) ''All teams spend 3 minutes developing a 1 minute introduction to their team'':
* Who we are (subgroup 1 if a larger team)
* What we do (subgroup 2 if a larger team)
* How we do it (subgroup 3 if a larger team)
* The major Challenges for us in what we do (subgroup if a larger team)
(b) ''All delegates write some SHORT SENTENCES/PHRASES on a piece of paper'':
* One ''hope'' for the training ahead
* One ''worry'' about the training ahead
* ''What are the some of the main challenges of your job?'' (These are your INDIVIDUAL experiences - as opposed to those shared by your TEAM earlier) ...With ''clients'', with your ''team'', and with your ''networks''.
These will be looked at while delegates then
(c) ...''Give us your current experiences of work, please''. Do the:
* Mini-PREACHY pre-training questionnaire
(d) ''Introducing ourselves and the model''
* Trainers have a conversation in front of the group:
** Attempting to mentalize the large group and themselves.
** Read out from hope and fears papers
** Imagine the large group is the client
** “There might be enthusiasts, there might be sceptics”
** Training may have benefits... AND it can have SIDE EFFECTS...
** Dialogue about "//them//", and about US...
** Stress AMBIT's requirement to [[Respect local practice and expertise]], and our ''non-knowledge'' about how things are here.
** We are “sailing blind” - very like working with the families you work with...
* The team's REFERRAL forms....
** Discuss and reflect upon these and the teams' proposed training outcomes...
* Reveal that we are trying to MODEL an AMBIT stance in our work with them.
** Broadcast our intentions
** Slide or two about the AMBIT project, the community of practice, who’s using it to date.
!!2. Open discussion (Q and A)
10 minutes
!!3. [[Training Exercises for Mentalization]]
45 minutes with slides
Show the [[Fishtank film clip]]
* Working in pairs
** Where was mentalizing?
** Where was non-mentalizing?
!!STOP FOR COFFEE (20 minutes)
!!4. [[Learning about AMBIT]] - 45 mins
* Applying Mz in 3 directions - clients/colleagues/networks (ask what the problems are in people's work - to scribe and to sort into 3 domains clients/team/network)
* Hard to reach/ relationship to help
* AMBIT stance first (see [[Core Features of AMBIT]]) and then move into the practices (“more detail in the afternoon”)
!!5. End of morning - How are we doing? (30 mins)
* 10 mins conversation with neighbour
* 'Call out' discussions with workers trying to represent their neighbour’s views
** We are modelling curiosity
** We are being explicit about whether we are attuned to their hopes and fears (from earlier)
!STOP FOR LUNCH - 1 hour
Meet team managers for 30 minutes - how's it going?
!!6. Mentalizing your client
[[The Therapist's Mentalizing Stance]]
[[Active Planning Map]] - the "Egg and Triangle" as a playing field to practice the mentalizing stance - including [[Broadcasting Intentions]].
!!7. Mentalizing the worker
Introduction to the idea of the [[Keyworker well-connected to wider team]] - EQUAL emphasis on inter-team relationships as there is on worker-client relationships...
Exercise: [[Passed-outwards Discussion]] - try it in threes
!BREAK FOR TEA (20 minutes)
!!8. Mentalizing the network
Introduction to the theme of [[Addressing Dis-integration]]
[[The AMBIT Pro-Gram]] to map out specific networks
Try it in pairs (day 2 we will do the [[Dis-integration grid]]
!!9. Wiki Manualization (30 minutes)
* 15 mins explanation of [[Manualization]]
* Exercise:
** Discuss examples from your team that might useful to manualize
** Things that are unclear
** Things which get people in the team a bit worried or upset or angry.
** Call out these afterwards
!!10. Wrap up 30 minutes
* Discuss the shape of the rest of the [[AMBIT training]] ahead
* Discuss the use of [[AMBIT Lead]]s and [[Implementation Science]]
* Point people at the MANUAL via:
{{{www.tiddlymanuals.com}}}
** Thinking about training outcomes for //your// team
** "NO SUCH THING AS AN AMBIT TEAM!"
!!11. Feedback forms completed
!!Finish

!This AMBIT Leads Training is MODIFIED for CAMDEN
The third day of this training is for the AMBIT lead(s) within the team. It is often helpful if this role is taken by two people in the team so often two people from each team attend this training day.
The learning objectives of this day are to:
# Provide an opportunity to consider the AMBIT lead role in your team
##[[The AMBIT Lead - role and responsibilities]]
##[[AMBIT LEADS - useful training pages]] gives a lot of useful pointers to learning for AMBIT Leads.
# Become familiar with the manual
##[[Using the Manual]]
# Plan a training event for you to facilitate in your team
##[[Planning a training event in your team]]
# Practice manualizing as a team process
##[[Manualization]]
!The approximate plan for the CAMDEN LEADS day:
* 09:00 - Coffee,
* 09.30 Reassurance: this is not an I.T. training... but!
** [[Register on TiddlySpace]] and get onto your local manual via WWW.TIDDLYMANUALS.COM
** During the day (breaks) we will be [[making you members of your local space|Making someone a member of a space]] and helping you [[Log in]] to local manuals.
* 10.00 Introductions and planning the day:
** Discuss in 3's ''Feedback from your teams''
*** What is the "temperature"?
*** What do THEY need?
** Clarify aims for today:
*** to define and refine key training outcomes for the Camden group of services
*** to understand the Camden transformation
*** to understand the role of the AMBIT Leads - Learning Support for teams.
*** to understand how to support a [[Learning Organisation|Developing learning organisations: the work of Peter Senge]]
*10.30am How do your services link together?
** Pick a theoretical complex scenario with conflict/competition
** [[Sculpt|Sculpting a network]] relationships and authority in the team.
** The notion of the [[Reflective Quorum]] to [[Scaffolding|Scaffolding existing relationships]] the existing power/authority structures, not undermine them!
** Discuss the use of [[Sculpting a network]] in local team trainings
* 11.00am Paul Carroll / Lola Nicholas
** understanding the Camden transformation
*** [[Camden - Integrated Family Framework]]
*** [[Camden - Core Family Record]]
* 11.30 Coffee
* 11: 50 What is an AMBIT lead?
** [[The AMBIT Lead - role and responsibilities]]
** The [[Role of the Team Learning Support Worker]]
** How can AMBIT Leads contribute to the Camden Transformation? Strengths, Opportunities, Weaknesses, Threats...
*** Small groups (3's or 4's)
*** Elect one member as "reporter", then discuss
*** [[Fishbowl discussion]] for the reporters
*** Whole group discussion - [[Manualization]] of this discussion
* Manualizing the AMBIT Lead role (SWOT analysis)
** See [[Camden AMBIT Leads - the view from new leads]] (live manualizing notes)
* 1:00pm Lunch
* 1:30pm Getting familiar with [[Using the Manual]]
** [[Find your way around]]
** Sharing material
*** finding who else is writing what ([[Comparing and Sharing functions]])
*** [[SNAPSHOT]]s
** Pages, and the [[Show references and info]] panel
** finding [[Videos]]
* 2:00pm Getting even more familiar with the manual
** Opening a new tiddler (page)
*** writing some text ([[Edit]])
*** [[Editing conventions|EditingConventions]]
* 2.30pm Thinking about the training needs of your team
** The next stage of training is [[Practising AMBIT Basic skills]] within the team, so as to have experience to reflect on at the final "Start-up" day of formal training.
** Exercise [[Planning a training event in your team]].
*3.30pm Tea
* 3:45pm The [[Manualization]] sequence
** Identify a problem ([[Role of the Team Learning Support Worker]])
** Team discussion; [[Team Meetings]] - ideas, reaching consensus, Chairing
** Recording: [[How to do team manualization]]
*4.00pm Manualize your work in the teams
** Manualize key pointers and priorities for AMBIT Lead practice
** Include addressing how AMBIT Leads in teams can support each other
*4.20 Reflections on the day
*4.30pm Finish

This training day does not involve any direct input from the AMBIT training team, but is hosted and run by the teams themselves.
The ongoing practice of AMBIT skills is an important part of the AMBIT approach which avoids a consistently "top-down" relationship to teams that have been trained. To a degree teams are encouraged to develop an [[AutoDidact]] capacity - organising themselves to practice locally, relating the content of their curriculum to local needs.
!Assessing need
Local teams can audit their own practice, using the APrAT (a self-audit tool) to identify training needs. Complete this with team discussion on:
* A ''"typical case"''
* A ''"hard case"''
* A ''"case we are doing well with"''
Where are the practice/theory gaps that might benefit from [[LEARNING at work]]?
Here is a training exercise, helping [[AMBIT Lead]]/[[AMBIT Local Trainers]] to identify what might be the most helpful areas to work on with their team, using the "reflective practice audit" that we call the [[AMBIT Practice Audit Tool (APrAT)]]. Particularly note the emphasis on teams working out how they might wish to adapt EXISTING STRUCTURES in their team, rather than add new tasks...
<html><iframe width="640" height="360" src="//www.youtube.com/embed/1ERcDJgTn3g" frameborder="0" allowfullscreen></iframe></html>
!Local training events
AMBIT promotes local teams to become increasingly [[AutoDidact]]ic (this is about [[Scaffolding existing relationships]]).
* See [[Planning a training event in your team]]
!Tips for AMBIT Leads to help embed AMBIT
The [[AMBIT Lead]] in a team is there to support the [[Implementation Plan]] for that team.
* See all the material at [[AMBIT LEADS - useful training pages]]
* See all the subtopics under the heading [[SUSTAIN best practice]]
* Place ''posters'' illustrating key AMBIT material to prompt behaviour change. Eg:
** [[AMBIT Wheel]]
** [[Thinking Together]]
** [[Dis-integration grid]]
* Use [[AMBIT stance playing cards]] in [[Team Meetings]].
* Help team members to [[Make the manual your Browser HOMEPAGE]].
* Use the [[SNAPSHOT]] button to share relevant pages from the manual with staff.
* If required find [[Organisational support for the technology to run TiddlyManuals]].

!The training objectives of the fourth day are:
# To review and reflect on what aspects of AMBIT are relevant and useful to the team (see [[AMBIT Practice Audit Tool (APrAT)]])
# To learn and practice using [[Mentalization]] in [[FamilyWork]].
# To write and record an [[Implementation Plan]]
# To practice [[Planning a training event in your team]]
!Plan for the day in Camden
''09.45'' Gather with coffee
''10.00 Start:''
* Help shape the plan for the day with whole group by completing following activity:
** //"As an individual practitioner, how much do I use the [[Core Features of AMBIT]]?// (use the APrAT audit tool in pairs).
* Identify 3 bullet points per pair - ''what additional focus for learning might prove useful to you in the future?'' - offer your list of 3 to neighbouring pair, who can select //one// to...
''10.20'' Feedback to group, identify areas of strength and training challenges
''10.30'' Recap [[Mentalization]] (brief - 10 minutes)
''10:40'' Practice [[The Therapist's Mentalizing Stance]], considering particularly [[FamilyWork]].
''11.30'' Coffee
''11.45'' Cover and practice [[Mentalizing Loop]], a variety of [[Mentalizing manoeuvres]] and practice [[Active Planning]] using the [[Active Planning Map]]
''1.00'' Lunch
''1.45'' Recap the AMBIT structure ([[Drawing the AMBIT Wheel]])
''2:00'' Practice [[Thinking Together]]
''2.30'' Recap [[Addressing Dis-integration]] and the [[Dis-integration grid]]
''2.45'' Tea
''3.00'' [[Manualization]] of a hot issue within your team
* [[Team Meetings]]?
* Links between the Vanguard Camden Service Principles and AMBIT's Principled stance in the [[Core Features of AMBIT]] - create a page linking across these.
''3.30'' Final exercise on [[Planning a training event in your team]];
''4.00'' Reflections on whole training and reminder about the [[Community of Practice]].
''4.30'' Finish
!Resources required
*AIM cards (twenty sets)
*Materials for 'barriers' exercise
* Screen and projector
* Wifi availability
* Sound for videos (just in case)
* Ideally TEAMS BRING THEIR OWN LAPTOPS WITH THEIR MANUAL
* Flipchart and pens
* PAPERWORK:
** APrAT forms
** AIM paper forms
** AMBIT Wheel on paper
** TRAINING FEEDBACK forms

!Setting and Context
* This day comes ''__after__'' a (new) Day 4 that is ''run locally by the team itself'' - clarifying their own implementation plan, practising locally, cementing the AutoDidact element of AMBIT that encourages [[LEARNING at work]]
!Principles
* The whole training is an example of the attempt to find an explicit balance between [[Respect for Evidence]] and [[Respect local practice and expertise]]
** Connecting <<tag [[LEARNING at work]]>> to day to day practice
** Acknowledging that there is some evidence that there are some things that //must be done//... ''it is not all about freedom of choice!''
* Day 5 is about clarification:
** ...Of the core [[AMBIT Competencies]]
** ...Of the minimum changes necessary (measurable by an outside observer) to say that ''//"we have tried this out"//'' and are now [[AMBIT-influenced]].
!Content
* Review their [[Implementation Plan]] as worked out by them on their Day 4
** The APrAT exercise
* Linking [[AIM]] to [[Outcomes]] and try the AIM cards...
** What are this team's local [[Outcomes measures]]?
** Using session-by-session monitoring
* Linking back to the original [[Pre-training team audit]]
!Typical Plan of the day (this may vary according to locations etc so please check timings)
09.15 Gather and have coffee
9.30 Feedback - make plan for the day with whole group.
10.10 The AMBIT wheel (see [[Drawing the AMBIT Wheel]])
10.30 As an individual practitioner, how much do I use AMBIT core features, and what might prove useful to you in the future? (use [[APrAT]] in pairs)
11.00 Feedback to groups in teams
11.15 Coffee
11.30 Whole team discussion about assessment methods in your team (use [[Elevator Pitch]] or [[Fishbowl discussion]] to present aspects of this)
|bgcolor(lightblue):<br>''1. The range of attitudes towards Outcomes in our team''<br>''2. How do decisions get made about what we are trying to achieve at work?''<br>''3. How do we find out if we are achieving what we have set out to do?''<br><br> |
12:00 Introducing the [[AIM]] - [[AIM Form]] and [[AIM Cards]]. Completing the AIM on an individual young person (in pairs)
12.15 Discuss use of [[Outcomes]] more generally - [[Respect for Evidence]]
1.00 Lunch
1.45 Introducing [[Implementation Science]]:
|bgcolor(pink):<br>''How do you create a ratchet for the team's learning and decision-making?''<br><br> |
2.00 Developing the team's [[Implementation Team]] and [[Implementation Plan]] - Now, Next, Why? (see [[Active Planning Map]])
2.45 Tea
3.00 [[Manualising|Manualization]] a hot issue within your team - ([[Team Meetings]]?)
3.30 Final exercise on [[Planning a training event in your team]]
4.00 Reflections on whole training
4.30 Finish
!Resources required
* Screen and projector
* Wifi availability
* Sound for videos (just in case)
* Ideally TEAMS BRING THEIR OWN LAPTOPS WITH THEIR MANUAL
* Flipchart and pens
* PAPERWORK:
** APrAT forms
** AIM paper forms
** AMBIT Wheel on paper
** TRAINING FEEDBACK forms

!Introduction
Descriptions of competencies can be a bit daunting and dry but they are also very useful in being clear about the core aspects of the model and what practitioners should know and do.
The AMBIT Project Group at the [[Anna Freud National Centre for Children and Families]] has been working on trying to define the core competencies for a practitioner working in an AMBIT trained team. We recognise that different teams will adopt some parts of the AMBIT approach more than others and that it is not a requirement that all practitioners are competent in all the 20 competencies outlined below.
We would greatly welcome comments and suggestions from current AMBIT trained teams about whether the competencies outlined here represent their understanding of the core AMBIT approach.
Adaptations of these competences for individual teams would be especially interesting and welcome.
! The overall competency framework for AMBIT
!!Individual Competencies
AMBIT competencies for individual workers are organised into three parts;
* ''Part A: Basic knowledge for AMBIT''
* ''Part B: Basic practice for AMBIT''
** [[AMBIT Competencies covered in the Basic Training]] lists the ten most basic components (Part A and Part B).
* ''Part C: Advanced knowledge and practice for AMBIT.''
** [[AMBIT Full Competency Framework]] adds ten further competencies (Part C) which are listed together with the ten covered in the Basic Training (Part A and Part B).
*** Thus, ''overall, there are twenty competencies''.
*** There is a self-audit scoring scheme included in that list
*** Embrace the importance of [[Work on the Self]] and use this to direct AutoDidact activities as teams or individuals.
!!Team Competencies
Because AMBIT is explicitly and exclusively a ~TEAM-BASED approach, there is also a list of team-based practices that require the kind of [[Working with your TEAM]] that AMBIT promotes:
* [[AMBIT Team Competencies]]

!What is this?
See [[AMBIT Competencies]] for a description this. The list below is ''just the first half'' of the [[AMBIT Full Competency Framework]] - that is, just the core elements of practice that we hope trainees will achieve in their initial [[AMBIT training]].
!~Self-AUDIT
A simple exercise in thinking about your skills is to rate yourself on each of the competencies. Rate yourself against each of the following 20 competencies according to the following scale:
|bgcolor(pink):<br>__''Scoring:''__ ''0'' = Not confident, ''1'' = Becoming confident, ''2'' = Confident <br><br> |
!PART A: KNOWLEDGE FOR AMBIT
!!1. Knowledge of the theory of [[Mentalization]]*
*An ability to draw on knowledge about the nature of mentalizing (see [[Mentalization]])
*An ability to draw on knowledge about the developmental basis of processes of mentalization (see [[Secure Base]] and [[Marked mirroring]])
*An ability to recognise mentalizing and patterns of non-mentalizing in both self and others (see [[Implicit mentalization]]; [[Explicit mentalization]]; [[Teleological thinking]]; [[Pretend mode]] and [[Psychic equivalence]])
*An ability to draw on knowledge that the vulnerability to loss of mentalization leaves the young person exposed to more primitive modes of experiencing internal reality that, in turn, undermines the coherence of self-experience (see [[Concrete Mentalizing difficulties]])
!!2. Knowledge of the AMBIT approach*
*An ability to draw on knowledge of the basic AMBIT framework (“core features”) summarised in the AMBIT wheel (see [[AMBIT Wheel]] and [[Core Features of AMBIT]]).
*An ability to describe the AMBIT stance and the principle of holding the balance between competing dilemmas that are represented in it (see [[The Therapist's Mentalizing Stance]] and [[General features of a "Mentalizing Stance"]]).
*An ability to describe the four key practices in the AMBIT approach and to understand the relationship between the four practices as part of an integrated approach to effective intervention (see [[Working with your CLIENT]]; [[Working with your TEAM]];[[Working with your NETWORKS]];[[LEARNING at work]]).
*An ability to recognise the limitations of the relative lack of evidence for the AMBIT approach for hard to reach young people (see [[Respect for Evidence]] and [[Is AMBIT evidence based?]]).
!PART B: AMBIT PRACTICE
!!3. Ability to use mentalization in their work with young people and their carers*
*An ability to draw on knowledge that the intervention aims at increasing the young person’s capacity to mentalize (see [[Highlighting and reinforcing Positive Mentalizing]]).
*An ability to draw on knowledge that AMBIT formulates some of the mental vulnerabilities associated with hard to reach young people as resulting from the fragility of mentalization in the context of attachment relationships (see [[Formulation and Treatment Aims]]).
*An ability to draw on knowledge of the developmental factors and experiences that are typically associated with a vulnerability to loss of mentalization (see [[Developmental Considerations]]).
*An ability to adopt the mentalizing stance in working with young people (see [[The Therapist's Mentalizing Stance]] and [[General features of a "Mentalizing Stance"]]).
*An ability to use the mentalizing loop in working with young people and their carers (see [[Mentalizing Loop]]).
!!4. Ability to apply mentalization to work with colleagues*
*An ability to draw on knowledge of mentalization to recognise that the mentalizing capacity of colleagues within a team (including oneself) is likely to fluctuate in response to anxiety, stress and other expected aspects of work with hard to reach young people (see [[Ripples in a Pond]] and [[Dive Boat]]).
*An ability to draw on knowledge of attachment and mentalization to work towards creating a sense of safety within a team in order to facilitate mentalizing in oneself and others (see [[Secure Base]]).
*An ability to draw on knowledge of attachment theory to recognise the value of availability and responsiveness in work between colleagues in a team (see [[Attachment theory]]).
!!5. Ability to apply mentalization to work across agencies and see problems from multiple institutional standpoints*
*An ability to make sense of the behaviour of staff from other agencies in terms of understandable mental states and intentions of agents in that organisation (see [[Addressing Dis-integration]]).
*An ability to recognise that beliefs about the practice of other agencies is likely to be influenced by unbalanced feedback patterns about such agencies (see [[Dis-integrative processes in a Multi-Agency context]]).
*An ability to adopt a position of respect towards staff from other agencies and to demonstrate this by positive curiosity about their work with the young person (see [[Non-mentalizing, positioning and network problems]]).
*An ability to accept that different agencies may be required to prioritise different aspects of a young person’s needs and that these different priorities may create tensions within a network around a young person (see [[Mentalizing service barriers]]).
!!6. Ability to intervene in multiple domains*
*An ability to make sense of a young person's difficulties by considering the impact of these problems on many areas of his/her life and to recognise the way that these difficulties are likely to interact together (see [[Working in multiple domains]]).
*An ability to work with both individual and systemic difficulties in trying to improve the life chances of the young person (see [[SystemsTheory]]).
*An ability to engage with the wider community such as schools, colleges and youth services in working with the young person (see [[Working with the Social Ecology]]).
* An ability to apply basic systemic ideas and techniques to intervening in relationship problems both within the family and between the family members and people in the wider community (see [[FamilyWork]]).
*An ability to consider how wider systems, commissioning arrangements, service procedures and local policies impact on the work with young people and to aim to support such systems to operate in a more coherent way (see [[Addressing Dis-integration]]).
!!7. Ability to scaffold existing relationships to provide help.
*An ability to explore with the young person their experience of relationships with others in their network and to facilitate the young person in mentalizing both their own and others’ experiences of such relationships (see [[Relationship to help]]).
*An ability to be guided by the young person about who may be most helpful to them about their key problems independent of the person’s professional status or background training (see [[The AMBIT Pro-Gram]]).
*An ability to focus work on building capacity and availability in existing (and potentially long lasting) resiliencies identified in the young person’s social ecology (see [[Focussing on Strengths]]).
*An ability to actively support (by joining them at meetings etc) a young person’s engagement with more mainstream therapeutic, educational or social care/youth agencies (see [[Working in multiple domains]]).
*An ability and willingness (temporarily, and with due attention to professional boundaries) to step outside of formally defined roles in order to support the work of another agency - if doing so supports the establishment of improved working and more effective intervention in another functional domain (see [[KeyWorker]] and [[Why intervene simultaneously in multiple domains?]]).
!!8. Ability to think together with colleagues*
*An ability to draw on knowledge about the high likelihood and impact of episodes of non-mentalizing in the worker doing work of this kind (see [[Features of UNsuccessful Mentalizing]] and [[Keyworker well-connected to wider team]]).
*An ability to apply mentalization in one’s interactions between colleagues within the team (see [[Work on the Self]] and [[Is Mentalizing just Reflective thinking?]]).
*An ability to use the ‘thinking together’ approach to consulting with a colleague in a team, as a way of ensuring that sense is made of the worker’s own feelings about a particular young person or clinical situation, and the possible impact of this upon the work. (see [[Thinking Together]]).
*An ability to respond to colleagues who seek help around a particular case in helping them to think together about the dilemmas around a particular young person or clinical situation (see [[Thinking Together]]).
*An ability to challenge colleagues where evidence of a non-mentalizing approach to the work is present, and to support them to regain their own mentalized explanations for the behaviours that they are working with (see [[Local Session 04: Working with your Team]]).
!!9. Ability to assess network functioning using a disintegration grid.*
*An ability to identify all key participants from the youth’s professional network who have an investment in the youth’s outcomes, including family members where appropriate and other formal and informal key stakeholders (see [[The AMBIT Pro-Gram]]).
*An ability to make sense of the behaviour of others in the network in terms of intentional mental states (e.g. to apply the same insistence upon mentalized explanations for behaviour in working with professional colleagues as in working with young people and their families) (see [[Addressing Dis-integration]]).
*An ability to work proactively to identify gaps (or dis-integrations) in the work of the multi-agency network, that might (mostly inadvertently) either diminish the effectiveness of the interventions by some parts of of the network, or damage the young person or family’s experience of contact with these various facets of “help” from the wider system by presenting them with conflicting or overwhelming demands (see [[Dis-integration grid]]).
*An ability to facilitate collaboration between professionals at all levels of the service system that takes into account professional beliefs about the nature of the young person’s difficulties, what may be helpful in addressing these problems, and beliefs about role responsibilities in a multi-agency system (see [[Dis-integration]]).
*An ability to help each of the key agencies to identify desired outcomes or initial goals, and to use this information to set overall treatment goals (see [[Advice on setting Treatment Aims and Goals]]).
!!10. Ability to manualize specific local practice.*
*An ability to use the local web based version of the AMBIT manual in a fluent and confident way:
**To locate the manual via a browser (www.tiddlymanuals.com)
**To open it and orient oneself to the sections of the screen desktop
**To navigate it and find specific material via the search function, via the indexes, or by following links, references and topics/sub-topics in the “Show related information” panel.
**To use the “Snapshot” function in the manual in order to share a specific page or set of pages with a colleague (see [[How to read this Manual]]).
*An ability to draw on basic knowledge as to how the manual has been constructed and how a local version of it may be adapted to describe and develop solutions to local service challenges (see [[I am authorized to edit to our local team's manual]]).
*An ability to engage in team discussion about important areas of practice with young people in order to develop a shared approach to a particular difficulty or situation that commonly arises with this client group (see [[How to do team manualization]]).
*An ability to contribute into achieving a consensus approach to common clinical dilemmas based on team reflection and discussion and to manualize practice guidance from this (see [[Respect local practice and expertise]]).
*An ability to reflect with team colleagues on interactions with young people and/or professionals in the network and in a systematic way agreed within the team (e.g. discussion in a team meeting) in order to enable collective learning about effective practice (see [[Team Meetings]]).
*An ability to make use of the team wiki manual in order to ensure that clinical decision making is consistent with evidence based practice and the AMBIT model as applied to the specific local team (see [[How to read this Manual]] which includes a video tour of the main features of the manual and [[Using the Manual]]).
----
See [[AMBIT Full Competency Framework]] for the extended list of competencies, and [[AMBIT Team Competencies]] for competencies relating to whole teams rather tan individuals.
----
!DEVELOPING EVIDENCE ABOUT THESE COMPETENCIES
!!!!Relative Importance and Use of these competencies:
We asked 41 AMBIT practitioners at the AMBIT conference 2014 to give each competency a relative rating of its ''importance'' and its ''use in current practice''.
High scores indicate more importance/use (see [[Competency use and importance ratings]]).

!Introduction
As AMBIT grows and its core content is shared by many teams, a more formal structure is under development to review and approve new material.
The original material in the manual was written by the listed [[Authors]], but as any reading of AMBIT will show, the nature of AMBIT is to //adapt// and develop to keep in touch with changing knowledge, evidence and experience, using access to the evidence base (eg [[Fonagy, Cottrell, Phillips, Bevington, Glaser and Allison (2014) What Works for Whom]]) as well as feedback from teams using the material in real world settings. Local versions of the AMBIT manual are developing a great deal of new content, and the authorship of this content is held by the local teams (see [[Who wrote which bits?]] and [[Comparing and Sharing functions]]).
<<tag [[AMBIT Editorial Group - current manualizing tasks]]>>
!The AMBIT Editorial Group
* As a pilot we have convened a small group of AMBIT trainers to review changes to the manual more systematically.
* The group meets regularly to review all changes to the core content of the AMBIT manual, accepting or rejecting proposed changes, and passing more substantial adaptations to the [[AMBIT training]] curriculum on for agreement by the wider AMBIT project team at their meetings.
* A ''minimum'' number of 3 members of the group needs to be present for editing to proceed (see [[Reflective Quorum]]).
** There will be a review of the work of this group in 6 months
** This will include the technical methods for recording their work.
* ''We invite expressions of interest from others (especially outside of the AMBIT 'community') to join this group.''
!Tasks for the Editorial Group
|bgcolor(pink):''1. Setting the processes, rules and criteria''<br>The AMBIT Editorial Group, with oversight from an [[AMBIT Expert Reference Group]], sets the processes up for managing content in the manual, the rules by which content is admitted to the core AMBIT platform, and the criteria by which such content is judged.<br>|
|bgcolor(lightblue):''2. Tracking and approving/rejecting NEW material''<br>''(a) PROCESS:''<br>We track new material that is added in the manual under two headings:<br><<tag [[(a) Work in Progress - Major change]]>><br><<tag [[(b) Work in Progress - Minor change]]>><br>''(b) RULES:''<br>(i) ''Very minor edits'' (correcting typos, repairing links, improving presentation) are not tracked at all.<br>(ii) ''Major and Minor changes'' to content can be made if this fulfils the [[Criteria for inclusion/exclusion of CONTENT in AMBIT]].<br>(iii) ''REMOVAL of the "Work in Progress" tags'' signifies that approval of the changes have been made. |
|bgcolor(pink):''3. Identifying and resolving duplications/contradictions in EXISTING content''<br>''(a) PROCESS:''<br>We are systematically screening for material that has been written in different ways and under different headings.<br>''(b) RULES:''<br>Rules for how to label and integrate new material - see [[Fitting what you ADD into what is ALREADY THERE in your manual]]. |
|bgcolor(lightblue):''To Do Lists:'' <br>This tag lists material that NEEDS EDITORING/AUTHORING WORK from the editorial group:<br><<tag [[AMBIT Editorial Group - current manualizing tasks]]>><br>These tags gather changes that need review and sign off:<br><<tag [[(a) Work in Progress - Major change]]>><br><<tag [[(b) Work in Progress - Minor change]]>><br> |
!Work in progress requiring sign-off by the AMBIT Project Group
!!(a) Standing item for sign-off by wider AMBIT Project Group:
(list pages below as [[Link]]s, that are currently being worked on that involve a change to the training curriculum/model)
* [list pages as links here]
* etc
* etc
!!(b) Early drafting:
See the @ambit-afc (local version of the manual for members of the AMBIT project at [[AFC]]) for content that is being worked prior to inclusion in the core content.
!Current Editorial Group membership:
[[DickonBevington]] - Chair
[[Peter Fuggle]]
[[Suzanne Hare]]
[[Liz Cracknell]]
[[John Lincoln]]
[[Garry Richardson]]
[[Sally Zlotowicz]]
[[Katie Partridge]]
[[Nick Jones]]
[[Olive Moloney]]

This is a tag that lists material that has been identified as needing further/new content authoring by the [[AMBIT Editorial Group]] and original [[Authors]] - you can see content gathered under this tag here:
<<tag [[AMBIT Editorial Group - current manualizing tasks]]>>
!Rules for editing and authoring
Please tag all new edits and authored pages with either
[[(a) Work in Progress - Major change]] or [[(b) Work in Progress - Minor change]]

The Editorial team is responsible for core content in the AMBIT manual
DickonBevington (Lead Editor)
[[Peter Fuggle]]

The AMBIT expert reference group consists of recognised experts who have agreed to provide occasional oversight of the AMBIT content. Recruiting to this group has started in late 2014, in recognition of the expanding population of AMBIT-influenced teams across the UK and internationally.

Via the [[Show references and info]] panel, above right, you can find links to a whole series of Frequently Asked Questions about AMBIT in general, that have arisen in trainings or conferences over the past years. Below you will see that tere are also FAQ's about the Training, and for Local Trainers.
This is a resource that will be built upon and we invite users of the manual to offer further suggestions using the [[Feedback please!]] form.
Click the button below to select a question you are interested in:
|bgcolor(pink): <<tag [[AMBIT FAQs]]>> |bgcolor(lightgray):General FAQ's about AMBIT |
|bgcolor(pink): <<tag [[Training FAQs]]>> |bgcolor(lightgray):~FAQs about the training process etc |
|bgcolor(pink): <<tag [[LOCAL trainers FAQs]]>> |bgcolor(lightgray):~FAQs for local trainers who have done the "Train the Local Trainer" training |

This is a tag that collects all the Tiddlers that include downloadable forms that can be used in the general process of assessment, formulation and care planning.

!Introduction
The [[AMBIT training]] aims to provide team members with [[AMBIT Competencies covered in the Basic Training]], but as AMBIT is a framework for [[LEARNING at work]], so the full range of competencies is wider. Listed below is the full range of competencies that team's should aim to cover. See also [[AMBIT Team Competencies]] that cover the [[Core Features of AMBIT]].
!~Self-AUDIT
A self-audit exercise is suggested with these competencies. Rate yourself against each of the following 20 competencies according to the following scale, in order to direct further training (including [[AutoDidact]] training):
|bgcolor(pink):<br>__''Scoring:''__ ''0'' = Not confident, ''1'' = Becoming confident, ''2'' = Confident <br><br> |
|bgcolor(lightblue):<br>The list below ''INCLUDES'' and ''ADDS to'' the ten [[AMBIT Competencies covered in the Basic Training]]<br>|
!PART A: KNOWLEDGE FOR AMBIT
!!1. Knowledge of the theory of [[Mentalization]]*
*An ability to draw on knowledge about the nature of mentalizing (see [[Mentalization]])
*An ability to draw on knowledge about the developmental basis of processes of mentalization (see [[Secure Base]] and [[Marked mirroring]])
*An ability to recognise mentalizing and patterns of non-mentalizing in both self and others (see [[Implicit mentalization]]; [[Explicit mentalization]]; [[Teleological thinking]]; [[Pretend mode]] and [[Psychic equivalence]])
*An ability to draw on knowledge that the vulnerability to loss of mentalization leaves the young person exposed to more primitive modes of experiencing internal reality that, in turn, undermines the coherence of self-experience (see [[Concrete Mentalizing difficulties]])
!!2. Knowledge of the AMBIT approach*
*An ability to draw on knowledge of the basic AMBIT framework (“core features”) summarised in the AMBIT wheel (see [[AMBIT Wheel]] and [[Core Features of AMBIT]]).
*An ability to describe the AMBIT stance and the principle of holding the balance between competing dilemmas that are represented in it (see [[The Therapist's Mentalizing Stance]] and [[General features of a "Mentalizing Stance"]]).
*An ability to describe the four key practices in the AMBIT approach and to understand the relationship between the four practices as part of an integrated approach to effective intervention (see [[Working with your CLIENT]]; [[Working with your TEAM]];[[Working with your NETWORKS]];[[LEARNING at work]]).
*An ability to recognise the limitations of the relative lack of evidence for the AMBIT approach for hard to reach young people (see [[Respect for Evidence]] and [[Is AMBIT evidence based?]]).
!PART B: AMBIT PRACTICE
!!3. Ability to use mentalization in their work with young people and their carers*
*An ability to draw on knowledge that the intervention aims at increasing the young person’s capacity to mentalize (see [[Highlighting and reinforcing Positive Mentalizing]]).
*An ability to draw on knowledge that AMBIT formulates some of the mental vulnerabilities associated with hard to reach young people as resulting from the fragility of mentalization in the context of attachment relationships (see [[Formulation and Treatment Aims]]).
*An ability to draw on knowledge of the developmental factors and experiences that are typically associated with a vulnerability to loss of mentalization (see [[Developmental Considerations]]).
*An ability to adopt the mentalizing stance in working with young people (see [[The Therapist's Mentalizing Stance]] and [[General features of a "Mentalizing Stance"]]).
*An ability to use the mentalizing loop in working with young people and their carers (see [[Mentalizing Loop]]).
!!4. Ability to apply mentalization to work with colleagues*
*An ability to draw on knowledge of mentalization to recognise that the mentalizing capacity of colleagues within a team (including oneself) is likely to fluctuate in response to anxiety, stress and other expected aspects of work with hard to reach young people (see [[Ripples in a Pond]] and [[Dive Boat]]).
*An ability to draw on knowledge of attachment and mentalization to work towards creating a sense of safety within a team in order to facilitate mentalizing in oneself and others (see [[Secure Base]]).
*An ability to draw on knowledge of attachment theory to recognise the value of availability and responsiveness in work between colleagues in a team (see [[Attachment theory]]).
!!5. Ability to apply mentalization to work across agencies and see problems from multiple institutional standpoints*
*An ability to make sense of the behaviour of staff from other agencies in terms of understandable mental states and intentions of agents in that organisation (see [[Addressing Dis-integration]]).
*An ability to recognise that beliefs about the practice of other agencies is likely to be influenced by unbalanced feedback patterns about such agencies (see [[Dis-integrative processes in a Multi-Agency context]]).
*An ability to adopt a position of respect towards staff from other agencies and to demonstrate this by positive curiosity about their work with the young person (see [[Non-mentalizing, positioning and network problems]]).
*An ability to accept that different agencies may be required to prioritise different aspects of a young person’s needs and that these different priorities may create tensions within a network around a young person (see [[Mentalizing service barriers]]).
!!6. Ability to intervene in multiple domains*
*An ability to make sense of a young person's difficulties by considering the impact of these problems on many areas of his/her life and to recognise the way that these difficulties are likely to interact together (see [[Working in multiple domains]]).
*An ability to work with both individual and systemic difficulties in trying to improve the life chances of the young person (see [[SystemsTheory]]).
*An ability to engage with the wider community such as schools, colleges and youth services in working with the young person (see [[Working with the Social Ecology]]).
* An ability to apply basic systemic ideas and techniques to intervening in relationship problems both within the family and between the family members and people in the wider community (see [[FamilyWork]]).
*An ability to consider how wider systems, commissioning arrangements, service procedures and local policies impact on the work with young people and to aim to support such systems to operate in a more coherent way (see [[Addressing Dis-integration]]).
!!7. Ability to scaffold existing relationships to provide help.
*An ability to explore with the young person their experience of relationships with others in their network and to facilitate the young person in mentalizing both their own and others’ experiences of such relationships (see [[Relationship to help]]).
*An ability to be guided by the young person about who may be most helpful to them about their key problems independent of the person’s professional status or background training (see [[The AMBIT Pro-Gram]]).
*An ability to focus work on building capacity and availability in existing (and potentially long lasting) resiliencies identified in the young person’s social ecology (see [[Focussing on Strengths]]).
*An ability to actively support (by joining them at meetings etc) a young person’s engagement with more mainstream therapeutic, educational or social care/youth agencies (see [[Working in multiple domains]]).
*An ability and willingness (temporarily, and with due attention to professional boundaries) to step outside of formally defined roles in order to support the work of another agency - if doing so supports the establishment of improved working and more effective intervention in another functional domain (see [[KeyWorker]] and [[Why intervene simultaneously in multiple domains?]]).
!!8. Ability to think together with colleagues*
*An ability to draw on knowledge about the high likelihood and impact of episodes of non-mentalizing in the worker doing work of this kind (see [[Features of UNsuccessful Mentalizing]] and [[Keyworker well-connected to wider team]]).
*An ability to apply mentalization in one’s interactions between colleagues within the team (see [[Work on the Self]] and [[Is Mentalizing just Reflective thinking?]]).
*An ability to use the ‘thinking together’ approach to consulting with a colleague in a team, as a way of ensuring that sense is made of the worker’s own feelings about a particular young person or clinical situation, and the possible impact of this upon the work. (see [[Thinking Together]]).
*An ability to respond to colleagues who seek help around a particular case in helping them to think together about the dilemmas around a particular young person or clinical situation (see [[Thinking Together]]).
*An ability to challenge colleagues where evidence of a non-mentalizing approach to the work is present, and to support them to regain their own mentalized explanations for the behaviours that they are working with (see [[Local Session 04: Working with your Team]]).
!!9. Ability to assess network functioning using a disintegration grid.*
*An ability to identify all key participants from the youth’s professional network who have an investment in the youth’s outcomes, including family members where appropriate and other formal and informal key stakeholders (see [[The AMBIT Pro-Gram]]).
*An ability to make sense of the behaviour of others in the network in terms of intentional mental states (e.g. to apply the same insistence upon mentalized explanations for behaviour in working with professional colleagues as in working with young people and their families) (see [[Addressing Dis-integration]]).
*An ability to work proactively to identify gaps (or dis-integrations) in the work of the multi-agency network, that might (mostly inadvertently) either diminish the effectiveness of the interventions by some parts of of the network, or damage the young person or family’s experience of contact with these various facets of “help” from the wider system by presenting them with conflicting or overwhelming demands (see [[Dis-integration grid]]).
*An ability to facilitate collaboration between professionals at all levels of the service system that takes into account professional beliefs about the nature of the young person’s difficulties, what may be helpful in addressing these problems, and beliefs about role responsibilities in a multi-agency system (see [[Dis-integration]]).
*An ability to help each of the key agencies to identify desired outcomes or initial goals, and to use this information to set overall treatment goals (see [[Advice on setting Treatment Aims and Goals]]).
!!10. Ability to manualize specific local practice.*
*An ability to use the local web based version of the AMBIT manual in a fluent and confident way:
**To locate the manual via a browser (www.tiddlymanuals.com)
**To open it and orient oneself to the sections of the screen desktop
**To navigate it and find specific material via the search function, via the indexes, or by following links, references and topics/sub-topics in the “Show related information” panel.
**To use the “Snapshot” function in the manual in order to share a specific page or set of pages with a colleague (see [[How to read this Manual]]).
*An ability to draw on basic knowledge as to how the manual has been constructed and how a local version of it may be adapted to describe and develop solutions to local service challenges (see [[I am authorized to edit to our local team's manual]]).
*An ability to engage in team discussion about important areas of practice with young people in order to develop a shared approach to a particular difficulty or situation that commonly arises with this client group (see [[How to do team manualization]]).
*An ability to contribute into achieving a consensus approach to common clinical dilemmas based on team reflection and discussion and to manualize practice guidance from this (see [[Respect local practice and expertise]]).
*An ability to reflect with team colleagues on interactions with young people and/or professionals in the network and in a systematic way agreed within the team (e.g. discussion in a team meeting) in order to enable collective learning about effective practice (see [[Team Meetings]]).
*An ability to make use of the team wiki manual in order to ensure that clinical decision making is consistent with evidence based practice and the AMBIT model as applied to the specific local team (see [[How to read this Manual]] which includes a video tour of the main features of the manual and [[Using the Manual]]).
''
!PART C: ADVANCED COMPETENCIES
''
!!11. Knowledge of the common difficulties of under-served, (or ‘hard to reach’) young people and their families/carers across [[multiple domains|Working in multiple domains]].
*An ability to draw on knowledge of the psychological and interpersonal difficulties experienced by young people and family members/carers with multiple mental health, educational and social needs who are not seeking help for such problems (‘[[Hard to reach]]’ or [[Under-Served]]).
*An ability to draw on knowledge of the multiple risks factors ([[Complexity]]) that influence hard to reach young people (e.g. at the level of the individual, family/carers, peer, school and community).
*An ability to draw on knowledge of [[Family]] phenomena commonly associated with the multiple mental health needs of a ‘hard to reach’ young person (e.g. disorganised [[Attachment]] patterns, inconsistent parenting style, negative marital interactions, psychiatric disorders ([[Diagnoses]]), [[Physical Health matters]]), Educational needs (see [[Educational-Vocational Training]]), the [[SocialEcology]] (such as social service entitlements and economic factors (e.g. poverty) in a young person’s life - see [[Social-Ecological Work]] and [[SubsistenceSupport]].
*An ability to reflect on the lack of [[Evidence]] associated with psychological therapies associated with this complex and often co morbid group
*An ability to draw on knowledge of the long term psychological, social and economic consequences of social exclusion such dropping-out of school, college and work and/or a history of offending (e.g. reduced wages, limited career opportunities and housing restrictions) and its links to [[Complexity]] and the nature of [[Hard to reach]] populations.
*An ability to draw on knowledge about the general (and specific local) approach to provision of services for such young people – and the psychological impact of multi-agency involvement in “complex” or “multi-problem” cases. See [[Addressing Dis-integration]].
!!12. Knowledge of Attachment theory and help seeking as a way of making sense of 'Hard to reach' young people.
*An ability to draw on knowledge of [[Attachment theory]] and the processes involved in help seeking, as well as the implications of lack of help seeking (or atypical forms of help-seeking) for young people whose [[Relationship to help]] may contribute to them being described as [[Hard to reach]].
*An ability to draw on knowledge that a [[Mentalization]] based approach is grounded in [[Attachment theory]].
*An ability to adapt methods of practice to take into account the young person’s previous experiences of seeking help from adults (see [[Adapt your discourse]] and [[Contingencies]], as opposed to [[Non-contingent]] responses).
!!13. Knowledge of systemic principles that inform the AMBIT approach
*An ability to draw on knowledge of [[SystemsTheory]] - that whatever affects one member of a system (e.g. a family, school or multi-agency network) may affect all other members.
*An ability to draw on knowledge that patterns of interaction within and outside a group may affect each member of that group (see [[Positioning Theory]]).
*An ability to draw on knowledge that patterns of interaction between professionals working with a young person may affect each member of such a network ([[Dis-integration]]).
!!14. Ability to engage with young people and their social context
*An ability to recognise the factors that inhibit [[Engagement]] with help for young people and to adapt the intervention to accommodate to these factors (see [[Relationship to help]] and the [[Therapeutic Bargain]]).
*An ability to identify trusted adults in the network around the young person (either family or professionals) and, where appropriate, to work through such adults in order to enhance the young person’s capacity to develop trust in others around key issues in his/her life (see StrengthsResiliencies and [[Scaffolding existing relationships]].)
*An ability to carry out a process of gradual [[Engagement]] with a young person through the use of persistence that takes into account a formulation of the young person’s difficulty in responding to offers of help.
*An ability to promote engagement by employing core clinical skills ([[Engagement techniques]] including ordinary skills such as empathy, warmth, reflective listening, reframing, flexibility and instilling hope for change).
*An ability to draw on knowledge that engagement is a process over time rather than a single event and that a young person’s behaviour (e.g. contacting the service when upset or angry) may indicate (through the lens of [[Attachment theory]]) positive shifts in [[Engagement]] as much as what they say about the relationship (e.g. you’re all rubbish).
!!15. Ability to complete an AIM assessment.*
*An ability to draw on knowledge about the value of carrying an assessment of different [[Domains]] of a young person’s life (see [[Working in multiple domains]]).
*An ability to complete an [[AIM]] assessment of a young person either with a member of the network who knows the young person well or a family member as part of an initial assessment of the young person’s needs.
*An ability to complete an [[AIM]] assessment with the young person either using an on-screen ([[AIM Form]]) or paper version ([[AIM - paper version]]) or by using the [[AIM Cards]] as a method of understanding the young person’s perspective on his life and problems.
*An ability to score the AIM assessment and to use the [[AIM Form]] in the AMBIT manual to generate suggested interventions for that specific range of presenting problems indicated from that assessment.
*An ability to share the results of an AIM assessment with the young person and to construct a shared understanding of its meaning.
!!16. Ability to develop a mentalized formulation of the young person’s difficulties
*An ability to summarise information about a young person from a range of different sources in a concise and coherent manner. See [[Formulation and Treatment Aims]]. This builds on the idea of providing //narrative continuity// (one of the [[Features of Successful Mentalizing]]).
*An ability to reflect on the [[Formulation and Treatment Aims]] and to develop a description of the young person that takes account of their likely mental states and intentionality.
*An ability to share this mentalized [[Formulation and Treatment Aims]] with the young person in a manner which supports the capacity of the young person’s mentalizing and does not raise anxiety and/or affect (for instance see [[Assessment for SUD-Rx - Giving Feedback]])
!!17. Ability to develop a shared care plan with the young person
*An ability to be curious about the young person’s ideas as to what would make his/her life better and, where possible, develop these into goals for the work together (see [[The Inquisitive Stance]] as part of [[The Therapist's Mentalizing Stance]])
*An ability to process information gleaned from, and about, the young person and their network, using peer/supervisory support where indicated, and to draw up a preliminary ‘roadmap’ for the therapeutic work that might be possible or necessary (see [[Active Planning]]).
*An ability to broadcast one’s own therapeutic intentions ([[Broadcasting Intentions]]), concerns, non-negotiables, hopes, etc, tentatively, as a “work in progress”, inviting authentic collaboration to develop a care plan that takes account of the young person’s beliefs’ about what will be helpful.
*An ability to communicate ideas about evidence based interventions (see [[Respect for Evidence]]) in ordinary language to a young person in order to discuss what is likely to be helpful , and why.
*An ability to liaise with the young person about how the agreed [[Care Plan]] is communicated with family members and/or the professional network - see [[Active Planning: a core process with clients]].
!!18. Ability to support the measurement of individual and team clinical outcomes
*An ability to recognise the importance of remaining curious as to whether a particular method of work with a young person is be experienced as helpful to them - see [[Outcomes]] and [[Respect for Evidence]]
*An ability to support and contribute to the development of systematic methods within a team to evaluating whether young people are experiencing the service as beneficial to their problems.
*An ability to focus on continued evaluation of outcome from multiple perspectives, ensuring that both the young person and the AMBIT worker communicate their respective viewpoints and consider the viewpoint of the other.
!!19. Ability to identify with, and access support from, the wider AMBIT Community of Practice.
*An understanding of the ideas behind the [[Community of Practice]] that AMBIT seeks to develop and support.
* An understanding of the way that the AMBIT tiddlymanual has “layers of authorship” – with all local versions sharing a common core, but being empowered to add to or overwrite this content in their own local version (see [[Using the Manual]]).
*An ability to locate links to other local versions of the AMBIT manual via the [[www.tiddlymanuals.com|http://www.tiddlymanuals.com]] signposting site
*An understanding of the “[[OpenSource]]” aspects of the development of AMBIT
*An ability to use the “[[+ Getting started]]” page in a local AMBIT manual to receive news updates on the manualizing work by other AMBIT teams in the AMBIT Community of Practice, and to “clone and customise” relevant pages from another team into one’s own local manual.
*An ability to identify whether a page in the manual exists in different versions in other local manuals, and to compare those two versions (see [[Comparing and Sharing functions]]).
!!20. Ability to reflect on one's own, and the team's fidelity to AMBIT
*An ability to access and use the APrAT self audit form in relation to a specific case.
*An ability to use this [[AMBIT competencies]] framework to evaluate one's own further training needs.
*An ability to audit the team's practice against the [[Core Features of AMBIT]]
*An ability to accept the inevitability of variation in [[Outcomes]] in one's work with young people and families/carers.
*Demonstrate an openness to accept and learn from outcomes that have proven less successful than intended (See [[LEARNING at work]].
!!DEVELOPING EVIDENCE ABOUT THE COMPETENCIES
!!!!Relative Importance and Use of these competencies:
We asked 41 AMBIT practitioners at the AMBIT conference 2014 to give each competency a relative rating of its ''importance'' and its ''use in current practice''.
High scores indicate more importance/use (see [[Competency use and importance ratings]]).

The following are useful pages in the manual - to look through as part of your initial training, but also to refer to in the future.
!1. AMBIT Training and Implementation in general
* [[AMBIT training]], especially:
** The [[AMBIT Basic Training Day 3 (AMBIT Leads)]]
** [[AMBIT Basic Training Day 4 (Local Practice Day)]]
* [[Implementation Science]]
** The [[Implementation Team]]
** The [[Implementation Plan]]
!2. How to help sustain AMBIT principles in the team
* [[SUSTAIN best practice]]
** See the [[Show references and info]] panel there to reveal all the sub topics relating to this...
!3. Holding a manualising conversation/meeting in your team.
* [[Manualization]] is the basic page with links from it that covers everything - but stuff you particularly need to be familiar with is on this page:
* [[How to do team manualization]]
!4. Technical skills for using the manual
* Note - we do not //equate// the manual with [[SUSTAIN best practice]]; it is just one tool for this.
* [[Video tour of the AMBIT manual]] - a VIDEO TOUR of the manual
* [[Using the Manual]] - the general page on USING THE MANUAL - this includes material on the best techniques for reading and searching content, as well as technical help and lots more.
* [[Organisational support for the technology to run TiddlyManuals]]
* How to [[Edit]], and the [[EditingConventions]] that let you make text look nice
!5. How to increase access of the manual to team members.
* Do check out the incredibly useful [[SNAPSHOT]] button to gather specific links to useful pages that you can email to colleagues.
* [[Make the manual your Browser HOMEPAGE]]
* Organisational support for getting the manual to work in a big IT system such as an NHS Trust: [[Organisational support for the technology to run TiddlyManuals]]
!6. How to run a team training event using the manual
* [[Planning a training event in your team]]
* [[Suggested Team Training Sessions]]
* Links to videos and exercises: [[AMBIT Training Tour]]
!7. How to develop and use the AMBIT Community of Practice
* See the material on [[Community of Practice]]
* See the [[Comparing and Sharing functions]] in the manual.
* Consider the use of QUID PRO QUO arrangements between teams, so that external "consultants" can swap between teams to observe discussions and provide mentalizing reflections - much like the [[Fishbowl discussion]] exercises we use in training.
* See the [[Search]] button that says "search all manuals" (try searching "Knife" as this throws up local material from CASUS and MAC-UK)

This is a tag which links together all the tiddlers (pages) relevant to the AMBIT lead role.
See the [[Show references and info]] panel on this page for lots of content related to this role.
See also:
* [[The AMBIT Lead - role and responsibilities]]
* [[AMBIT LEADS - useful training pages]]
The AMBIT approach does not prescribe on the organisational structure for a team using AMBIT. It assumes their will be a variety of leadership arrangements within different teams. However, AMBIT practice is unlikely to be sustained without one or preferably two people within the team taking on the role of sustaining the skills and practice of AMBIT - which we refer to as the [[AMBIT Lead]] and the [[Implementation Team]].

!Work in Progress
This is a system that is currently (June 2015) being brought in to AMBIT training - but is not yet fully operational.
!What is this?
* A peer-to-peer support system for a pair of [[AMBIT Lead]]s in one team to connect with a pair in another team.
* This relationship is established during the AMBIT Lead training
* Allocation of AMBIT peer-to-peer partnerships:
** Peers are allocated by the AMBIT training project team before the [[AMBIT Basic Training Day 3 (AMBIT Leads)]]
** The criteria are variable but will include similarity of work, geographical proximity, etc
* We emphasise that ''this is a WORK relationship, not a social relationship''!
** There is no block on the formation of alternative or additional peer-to-peer relationships.
!What is the intention?
* To keep AMBIT on the agenda of a local team
* To create an opportunity for [[AMBIT Lead]]s to co-train their own team alongside a visiting [[AMBIT Lead]] (or [[AMBIT Local Trainers]]) from another team, using [[Local AMBIT training session plans]]
* To increase the confidence and competence of the [[AMBIT Lead]]s
* To create teams that are not only [[Well connected|Keyworker well-connected to wider team]] internally, but externally, too - across the the AMBIT [[Community of Practice]].
!How might it work?
* Introduction at the [[AMBIT Basic Training Day 3 (AMBIT Leads)]]
!Barriers for this to work
* It could be exposing for an AMBIT Lead from one team to talk to the AMBIT Lead from another team about //what is making this work hard//.

!9.30 Welcome
* ''Geographic sculpt for introductions''
** Floorspace = the UK
** locate N, S, E and W
** locate London and Edinburgh...
* All delegates to stand where their team works
** call out who you are and what you do
* Form groups of 4 - 6
** Pair up with the nearest other team(s)
!!Marking the task
Why are we here? Stating intentions, and naming a case where it worked...
|bgcolor(pink):''(a)'' Share ''something that's has worked well'' in your team, that people might have described as //"Very AMBIT!"//<br>''(b)'' This is hard to do... Share some observations of ''real practice which might have provoked the comment: //"That's not very AMBIT!"//'' |
!!10.00 Back to Basics.
* [[Thinking Together]]. Work with someone from another service around a hot case or issue.
* [[Sculpting a network]]. Whole group work on a selected case from one of the group. Create a [[Dis-integration grid]] as we go.
!!!11.00 Coffee
!!11.15 What does leading mean?
* [[Holding the Balance]] between Localism Vs Centralism
|bgcolor(pink): ''Debating the issue''<br>[[Line-ups - exploring individual differences]] ...From //"Whose side are you on?"// to //"Where do you stand on the continuum?"//: <br>''Extreme Localism (wild heterogeneity) Vs. Rigid Centralism (brutal conformity)'' <br>Where is the balance to be found? Have we got it right or wrong yet? |
*[[Competency|AMBIT Competencies]]:
|bgcolor(pink): The idea of [[individual|AMBIT Full Competency Framework]] and [[team|AMBIT Team Competencies]] competency. ''Is this useful?''<br>What would be ''your //"non-negotiables"// in an AMBIT fidelity measure''? |
*[[The AMBIT Lead - role and responsibilities]]
|bgcolor(pink): A self appraisal in pairs against the AMBIT Leads Job description |
*[[Manualising|Manualization]] the key learning points from this session
!!!1.00 Lunch
!!1.45 Learning and training and all that jazz.
*Organisational barriers to AMBIT:
** what are they and are they too big for comfort?
*Recognizing small changes
** Devising a 15 minute training event. Running it and getting feedback.
*[[Manualising|Manualization]] the training.
** Make it better next year
*Putting outcomes at the centre:
** How to?
** The IAPT experience - session-by-session outcomes
** POOLING OUTCOMES
!!4.00 Developing a [[Community of practice]].
* Getting beyond 'good' intentions.
* [[AMBIT Lead peer-to-peer system]]
* Whole group discussion to [[manualize|Manualization]] the AMBIT programme plan for 2014-2015.
!!4.45 Finish

!! AMBIT as a learning organisation revisited
This can be found in pages linked together by [[Developing learning organisations]]
''What is your team good at learning about?''
New games on the net? How to help each other? New drugs on the streets? New music? New fads for young people? How do they learn these things? [[Senge: Discipline 2 - Personal Mastery]]
''Learning about helping?''
Isn't this a bit wierd? Isn't it just instinctive? Like learning about having a sense of humour. Or learning about kindness? Let's take an example 'Learning how to put young people at their ease'
!!Manualizing
Manualizing is a method to support learning in groups or teams.
For a simple introduction to the manual go to [[Using the Manual]]
A broader introduction to editing content can be found in pages linked together by [[Manualization]].
''Manualizing and mentalizing''. The need to incorporate differences in the way a team comes to know its own way of working. Differences in confidence or belief around a particular issue. Otherwise it becomes just the voice of a dominant culture. Senge encourages people to //"listen for the whispers in a team"// - see [[Developing learning organisations]].

The suggested plan for this webinar is to invite two of the participants to present a case that the team has worked with. The aim would be to do this by presenting the core aspects of the case and to try to consider it from the perspective of working from the fours parts of the AMBIT approach.
The rest of the group would act as a reflecting team particularly focusing on mentalizing and there own reflections on the case. Each case would take 20 minutes so that we had 10 minutes a the end to conclude the series of webinars and consider what next.

What does the manual say about ''working with your client?''
Too much! The manual has a wide range of material focusing on ''working with your client''. The main sections of this are shown in the opening page of this section [[Working with your CLIENT]]. Let's look at this together for a few minutes.
From this array of material, the aim of this webinar is to focus on two aspects; the young person's ''relationship to help'' and the worker's need to dance around this, a process which we have called ''active planning''. The webinar will take as its starting point the following three pages from the manual.
[[Relationship to help]]
[[Active Planning: a core process with clients]]
[[Active Planning and the therapeutic journey]]
The aim of the webinar will be to look at this material together and then consider how it applies to the respective services and teams that participants come from.

!!!''Getting started.''
How do local teams in your area see your team/service? What would be some of the characteristics that they may assign generally to your team? What intentions would they assign to your team? Could you imagine a malign intention that might arise in their minds!!?
!!!''Why do networks matter?''
The idea is that well integrated networks are likely to improve effectiveness. The direct evidence for this is uncertain despite it appearing to be a common sense idea. Formal evaluation of this hypothesis in the Fort Bragg study provided disappointing results with no improvement associated with greater integration of care. its value may be partly an extrapolation from family studies which suggest that parents who work together are likely better care for their offspring than those who are in conflict. Recent observations from the Edinburgh service has suggested that greater effectiveness may be associated with fewer professionals being involved in the case. The causal direction of this association is uncertain.
!!!''Messing up''
Can you identify examples where your team inadvertently undermined the intervention of another service? PF to share a recent example from CAMHS
!!!''Using disintegration grids?''
How does this work in practice? Are they used? Can we share examples where this resulted in useful shifts in the functioning of the network?
!!!''What training challenges does working with networks present?''

!Introduction:
What are the ''boiled-down essentials'' for understanding about [[Working with your TEAM]]?
* See the sub-topics that fall under this heading: <<tag [[Working with your TEAM]]>>
** The <<tag [[AMBIT-Teamworking]]>> sub-topic contains a lot of material that has been validated through the experience of multiple teams trained (the [[Community of Practice]])
* But AMBIT is not just about dancing to someone else's tune, though;
** It is also very much about a LOCAL team adopting a systematic approach towards developing, clarifying and sharing it's own sense of identity, mission, and techniques, and situating them in relation to EXISTING EVIDENCE for what is safe and helpful
** In other words it is about developing <<tag [[OUR Team]]>>
!In a nutshell
We think that the most important elements to grasp are:
* [[Keyworker well-connected to wider team]] and the Team around the worker
** Remember that [[Mentalization]] is born //and recovered// in the context of relationships of trust.
* The disciplined use of [[Mentalization]] between worker peers in holding critical work conversations:
** ie [[Thinking Together]]
** Consider //ways to prompt and nudge the team// towards developing this as part of their own team culture.
* The idea that local teams are AMBIT-influenced, not "AMBIT teams" and take responsibility for LEARNING and DEVELOPING their own sense of "who we are and how we work"
** [[Manualization]] and see [[Local Manualization Homework Tasks]]
** How do your [[Team Meetings]] reflect your AMBIT influences?
** The APrAT

!Task - define a shared problem
!!1. Dealing with a ''//lack of enthusiasm//'' in team members
* Acknowledging the inertia that political situations/funding/job insecurity etc tend to bring.
* Risk of disappointment if early sessions are seen as "falling flat"
* Moving from Quick Fix to patient work towards a longer term goal
!!!Ideas
* Moving from Quick Fix to Quick Wins - clarifying clear objectives //that make sense to the team// early on
** "Doing AMBIT" is ''NOT'' an objective! Avoid connecting outcomes to "doing AMBIT" - stick with benefits for clients... and yet to avoid making outcomes focus into a BURDEN
** MAYBE having staff feeling more enthusiastic about the work is an OUTCOME in itself?
*** Playfulness - the play of ideas
**** //"Suivrez la Juissance!"// (follow the joy/juice!) - Lacan
*** The capacity of the team to EXPLORE together
*** To ACCEPT the stressfulness of the work we do, including thinking about new ways of working together.
**** //"Making the best of an impossible job"// - Bion
* Think about what might help members of this team feel SAFE enough to do this work, or unsafe in ways that inhibit such exploration?
* Team's capacity to use [[Mentalization]] for itself will likely have an impact on how successful it is in working with young people.
!!2. Risk that ''//we are perceived as dangerous "agents of change"//''
** Implicit sense of a hierarchy ("you went off to London")
** Getting into fights about control/letting go
** Telling team they are "doing it wrong"
** that "you are more equal than we are"
!!3. Concerns about the ''//dependence upon specific person (me)//''
* That it's "//up to you to DO AMBIT TO THE TEAM//"!
** Need to make ways for this to be a shared enterprise
** Creating curiosity to listen
!!4. ''//TIME and other PRACTICAL concerns//''
* Avoid this being an ADDITIONAL BURDEN,
* Avoid a focus on "WHAT" (else) we should be doing, and rather for this to be about "HOW" we do what we already do.
!!5.''We are trying to train "old hands"''
* Our "trainees" know all the tricks about trying to implement change in behaviours!
* Keep our practice and methods transparent ([[Broadcasting Intentions]])
!Principles/Resources
* Define our [[AMBIT]] - where can we expect to have influence?
** We have control over what we communicate about our work
** We have the capacity to (make an effort to) mentalize our work colleagues
* We have existing relationships within these teams
* ''"If isn't broken, don't fix it"'':
** There are probably things //this team, here// does NOT need any training on
* ''Openness'':
** Supporting conditions for a team to recognise that not all we do is crowned with success all the time
** This is a policy agenda - engaging in dialogue about which of our policies address our needs, and which need improvement.
!Ideas
* Offering feedback on our experience first, rather than unfolding an "agenda for change" ([[Broadcasting Intentions]])
* Inviting hopes and concerns from the team - keep it snappy!
* What are the things this team does very well, that any training must NOT BREAK!
* Creating an initial schedule with the team
* Encourage/foster "Yes, AND!" responses, rather than Yes, BUT"
!Measures of effective change
* How would you know this had made a positive difference?
** How would the team define critical positive change?
** See material on [[Implementation Science]]
** Consider your [[Implementation Plan]]
** Recruit your [[Implementation Team]]

A new role, for a new model of training ([[Training the Trainer (TTT) - training model]]), that is in development in 2014. These are local team members, who will have training and ongoing support in this role.
Also referred to as [[ALT]]'s!
There are some FAQ's for ALT's here: <<tag [[LOCAL trainers FAQs]]>>

!!The AMBIT Pleasure and Pain at Work Questionnaire
List five things that you enjoy about your work with young people and their families. Rate each item on a scale of 1-10 as to how much you enjoy this aspect of the job. (10 is a lot; 1 is only a bit)
!!! What you find enjoyable working with your clients Rating (1-10)
1.
2.
3.
4.
5.
!!! What you don't find enjoyable about working with your clients Rating (1-10)
1.
2.
3.
4.
5.

CRITERIA for accreditation as an AMBIT-accredited team:
* i. Creating at least one film about local AMBIT-influenced practice and publishing this in their local manual.
* ii. Having a one year [[Implementation Plan]] which should include:
** [[planned in-house trainings|Planning a training event in your team]] - with evidence they have been delivered.
** At least one visit from an [[AMBIT Lead]] or another [[AMBIT Local Trainers]] from another AMBIT-influenced team.
* iii. The team is able to demonstrate adaptation of AMBIT to local practice:
** Create a series of pages in the manual.
** Present a series of APrAT audits
** Self-assessed AMBIT competencies using the [[AMBIT Full Competency Framework]].
* iv. [[AMBIT Lead]]s take part in monthly half hour [[Telephone Implementation Support]] calls, from a nominated AMBIT trainer (nominated during the AMBIT training).

!What is the APrAT?
This is a simple questionnaire and exercise to give teams a basic reflective measure of how closely they have followed AMBIT principles in a particular case, and to help them [[SUSTAIN best practice]].
!How to do it?
|bgcolor(lightgray):<br>Try to do at least one APrAT every three months with the team. <br><br>1. Set aside an hour to do this - see the [[APrAT exercise in, or across, teams]]. <br>2. Pick one case - preferably one that has given particular cause for concern in the recent past.<br>3. Using the questions below, audit the 8 AMBIT stance indicators (see [[Core Features of AMBIT]]) around this case. <br>4. Look at the results, identify //which stance indicator is the most relevant for the team to improve its practice//, and look at the [[AMBIT Stance Exercises]] to locate a relevant exercise to practise this.<br><br> |
!The Questionnaire:
|bgcolor(lightblue):<br>1. ''Download a PDF version'' [[here|https://drive.google.com/file/d/0B5h_CVBdhJPYTng0VXV1RkxaX3c/edit?usp=sharing]]<br>2. See the PDF version of the APrAT questionnaire [[here|PDF version of the APrAT questionnaire]]<br>3. See the online version directly below<br><br> |
!Video introduction
Using an APrAT questionnaire to help you plan the local training sessions that your team might benefit from.
<html><iframe width="640" height="360" src="//www.youtube.com/embed/1ERcDJgTn3g" frameborder="0" allowfullscreen></iframe></html>
!APrAT QUESTIONNAIRE
!1. [[Mentalization]]
|Have you maintained a mentalizing stance with the young person/family?||Yes/No|
|Do you have a mentalized understanding of their difficulties?||Yes/No|
!2. [[KeyWorker]] relationship
|Has the keyworker developed a //consistently attuned// relationship with the young person?||Yes/No|
|Has the team kept to all the arrangements and plans it has made with the young person and family?||Yes/No|
|Would the young person call the keyworker or the team if they were worried?||Yes/No|
!3. [[Keyworker well-connected to wider team]]
|Are you “checking in” regularly with other team members, as well as receiving regular supervision?||Yes/No|
|Is it possible to consult and comment on each other’s practice in a sensitive, mentalized fashion?||Yes/No|
|Are team members using phones in the field, using 'Passed Outwards discussion'/'Thinking Together' routines?||Yes/No|
!4. [[Scaffolding existing relationships]]
|Have you identified resiliencies in existing relationships in your client’s informal network?||Yes/No|
|In their Professional Network?||Yes/No|
|Have you Care Planned work to strengthen these?||Yes/No|
!5. [[Managing Risk]]
|Have you completed/updated a risk assessment?||Yes/No|
|Have you kept notes up to date?||Yes/No|
|Have you kept to other governance protocols, or noted explicitly how and why you have had to diverge from these?||Yes/No|
!6. [[Working in multiple domains]]
|Across the whole professional network, which [[domains|Working in multiple domains]] have interventions care-planned for them?| Deployed | Not yet Deployed |
|..............................................................|.................................|....................................|
|..............................................................|.................................|....................................|
|..............................................................|.................................|....................................|
|..............................................................|.................................|....................................|
|..............................................................|.................................|....................................|
!7. [[Taking Responsibility for integration]]
|Have you done a Dis-integration grid?||Yes/No|
|Have you done any interpreting of other agencies for the young person or family/carers?||Yes/No|
|Have you managed, hosted or encouraged any “[[Connecting Conversations]]” between different parts of the network?||Yes/No|
!8. [[Respect local practice and expertise]]
|Is there evidence of unresolved inter-professional or inter-agency conflict in your practice?||Yes/No|
|Is there evidence that you have acted to minimize this?||Yes/No|
|Do team members hold respectful boundaries in discussions about other professionals?||Yes/No|
!9. [[Respect for Evidence]]
|Have you completed an [[AIM]], or other outcomes measures?||Yes/No|
|Have you consulted your team's local manual or other sources to identify best evidence-based practice relating to this case?||Yes/No|
|With the whole team, have you manualized any particularly effective practice, or new learning, from this case?|| Yes/No|

!Supervisory Structures
*Close adherence to the SupervisoryStructures are one of the [[Core Features of AMBIT]] practice.
**Supervision in [[AMBIT]] is more than simply meeting regularly, or occasionally, to talk about work, ensure fidelity of methods, check on training needs and career progress, etc.
**Supervision in [[AMBIT]] is much more dynamic and takes a number of forms.
*[[AMBIT]] does not attempt to replace local [[Governance]] structures, but to reinforce them.
***Individual staff members are expected to fulfil any local supervisory commitments.
*** //In addition// there are weekly [[Team Meetings]] that provide group supervision.
*Another of the [[Core Features of AMBIT]] describes a [[Keyworker well-connected to wider team]]
**This refers to the use of team members for on-the-spot peer-to-peer supervisory contact.
**Such peer-to-peer consultation functions according to clearly defined [[Rituals and Disciplines]] such as [[Thinking Together]].
!Boundaries of Competence
* There are [[AMBIT Competencies]] documented.
* The KeyWorker must always remain within the boundaries of his or her competence.
** Practitioners in the field are respnsible for their clinical practice
** [[AMBIT training]] is strongly recommended before working in an AMBIT service.
* Avoiding Omnipotence
** A risk in developing multi-skilled practitioners who can work relatively independently in an outreach setting is that a KeyWorker might develop rather 'omnipotent' ideas about what he or she is able to handle.
** The risk in such a situation is of workers who //assume// more expertise than they have, who fail to use the SupervisoryStructures available, and get caught in a situation that escalates and places people at risk of harm.
** Such omnipotence would represent a loss of one of the key features of a [[Mentalization]]-based approach - which is the quality of //tentativeness//, assuming the opaque nature of other people's minds (we cannot know the contents of another person's mental experience - we can only infer, guess, or ask.)
** This aspect of practice is covered in [[Maintaining Mind-mindedness]].
** Use of SupervisoryStructures is a key protection against the risk of breaking this important boundary.

Here we are just gathering all the various [[Training exercises]] in the manual together under headings that sort them according to which area of the AMBIT stance they best support:
!On the AMBIT stance and ways of working //as a whole//:
<<tag [[Training Exercises on AMBIT in general]]>>
!On the separate components of the Stance:
<<tag [[Training Exercises for Mentalization]]>>
<<tag [[Training Exercises for the Keyworker Relationship]]>>
<<tag [[Training Exercises for Keyworker well-connected to wider team]]>>
<<tag [[Training Exercises for Scaffolding existing relationships]]>>
<<tag [[Training Exercises for Managing Risk]]>>
<<tag [[Training Exercises for Working in multiple domains]]>>
<<tag [[Training Exercises for Taking Responsibility for integration]]>>
<<tag [[Training Exercises for Respect local practice and expertise]]>>
<<tag [[Training Exercises for Respect for Evidence]]>>

The [[AMBIT Full Competency Framework]] describes 20 competencies for an individual worker in an AMBIT trained team. However, AMBIT is unambiguously a team approach and alongside this individual framework we are developing some ideas about what a team competency framework would look like. This page indicates some initial work on this idea. Our proposal is that an AMBIT team could be identified as having five core competencies of its work. These are:-
The team's ability to:-
#''Mentalize the Client''
#''Mentalize the Team''
#''Mentalize the Network''
#''Learn as a team''
#''Evaluate client outcomes''
We have tried to think about how a team competency can be demonstrated. For each of the five competencies, we have included a list of possible alternative ways in which this aspect of team practice could be shown. Teams are not expected to do all of these but if they are doing none of them, then perhaps a part of the AMBIT model is not being used. This may be appropriate but it would seem useful if it is explicit and choosen rather than happening by default.
However, we are nervous about appearing to reduce a competency to a single practice. This would be unhelpful but, at the same time, if there is no explicit way by which a competency could be observed to be taking place, there is a possibility that the competency itself may be marginal to mainstream team work. As ever, the AMBIT approach is to try to balance top down definitions with appropriate local adaptations.
!1. Mentalizing the client
An ability for the team to support each other in drawing on knowledge that the intervention aims at increasing the young person’s capacity to mentalize.
An ability for the team to support each other in adopting the mentalizing stance in working with young people.
An ability for the team to support each other in using the mentalizing loop in working with young people and their carers.
!!!Team Practices that support Mentalizing the Client
*Group supervision in which a team member presents a case and the rest of the group mentalize the client and the worker either through discussion or through role play.
*Explicitly using the mentalizing stance or the mentalizing loop in joint work with young people
*Using mentalizing based formulations as the basis of casework interventions.
*Using the mentalizing approach explicitly as part of individual supervision.
!2. Mentalizing with your team
An ability for the team to support each other in recognising that the mentalizing capacity of colleagues within a team (including oneself) is likely to fluctuate in response to anxiety, stress and other expected aspects of work with hard to reach young people.
An ability for the team to support each other in using the ‘thinking together’ approach to consulting with a colleague in a team, as a way of ensuring that sense is made of the worker’s own feelings about a particular young person or clinical situation, and the possible impact of this upon the work.
An ability for the team to support each other in being able to challenge colleagues where evidence of a non-mentalizing approach to the work is present, and to support them to regain their own mentalized explanations for the behaviours that they are working with.
!!!Team Practices that support Mentalizing the Team
*Using 'thinking together' method of case discussion in team meetings.
*Using 'thinking together' in individual supervision.
*Training all new staff in the team about 'thinking together'
!3. Mentalizing the Network
An ability for the team to support each other in making sense of the behaviour of staff from other agencies in terms of understandable mental states and intentions of agents in that organisation.
An ability for the team to support each other in adopting a position of respect towards staff from other agencies and to demonstrate this by positive curiosity about their work with the young person.
An ability for the team to support each other to identify all key participants from the youth’s professional network who have an investment in the youth’s outcomes, including family members where appropriate and other formal and informal key stakeholders.
An ability for the team to support each other in facilitating collaboration between professionals at all levels of the service system that takes into account professional beliefs about the nature of the young person’s difficulties, what may be helpful in addressing these problems, and beliefs about role responsibilities in a multi-agency system.
!!!Team Practices that support Mentalizing the Network
*Using the method of network sculpting to reflect on difficult cases
*Using the dis-integration Grid as part of case formulation
*Using network sculpting as part of team training events.
!4. Learning as a Team
An ability to reflect with team colleagues on interactions with young people and/or professionals in the network and in a systematic way agreed within the team (e.g. discussion in a team meeting) in order to enable collective learning about effective practice.
An ability for the team to support each other to make use of the team wiki manual in order to ensure that clinical decision making is consistent with evidence based practice and the AMBIT model as applied to the specific local team.
An ability for the team to support each other to engage in team discussion about important areas of practice with young people in order to develop a shared approach to a particular difficulty or situation that commonly arises with this client group.
An ability to contribute into achieving a consensus approach to common clinical dilemmas based on team reflection and discussion and to manualize practice guidance from this.
!!!Team Practices that support Learning as a Team
*Having planned manualising meeting at set times throughout the year.
*Using the manual as part of case discussion.
*Re-writing aspects of core AMBIT practice adapted to local service needs
!5.Evaluating Client Outcomes
An ability for the team to support each other to recognise the importance of remaining curious as to whether a particular method of work with a young person is be experienced as helpful to them.
An ability to support and contribute to the development of systematic methods within a team to evaluating whether young people are experiencing the service as beneficial to their problems.
An ability to focus on continued evaluation of outcome from multiple perspectives, ensuring that both the young person and the AMBIT worker communicate their respective viewpoints and consider the viewpoint of the other.
An ability of the team to support each other to complete an AIM assessment with a young person or with a member of the network who knows the young person well or a family member as part of an initial assessment of the young person’s needs.
!!!Team Practices supporting Evaluating Client Outcomes
*Having a systematic method of recording client outcomes at the point of discharge
*Discussing client outcomes as part of team awaydays.
*Reporting on client outcomes to the commissioners and including the team in such reports
*Meeting with young people to consider outcomes and how these could be improved.

AMBIT was originally devised out of work developed by a group of practitioners at the Anna Freud National Centre for Children and Families and the Marlborough Family Centre.
At the current time (2016), the AMBIT Project has three senior AMBIT trainers - [[DickonBevington]], [[Peter Fuggle]] and [[Liz Cracknell]] who are based at the Anna Freud National Centre for Children and Families and four AMBIT Trainers:
and a further two Lead Trainers:
Suzanne Hare
Laura Talbot
There are also [[AMBIT Assistant Trainers]] who are experienced practitioners currently working in [[AMBIT-influenced]] teams

!1. Expression of interest
*Enquiries about [[AMBIT training]] from teams/services go to [[The AMBIT Project Coordinator|mailto:ambit@annafreud.org]].
*We will send out published papers and a link to the AMBIT manual
*We will also make initial enquiries about the size of the team, whether it is statutory or voluntary sector and annual income of the team if voluntary sector.
*We will ask the enquirer to fill in an Expression of Interest form
!2. Engagement meeting
See more detailed notes at [[Initial engagement - notes for trainers]]
* A manager and senior clinician will have a telephone/web call with an AMBIT Lead Trainer
* This is largely a [[Briefing session for senior managers/commissioners]]
* Face-to-face meetings are possible at the expense of the applying team
* Meetings should follow this general process:
** Introductions and agenda setting
** Discuss team's existing work context
** How much do you know about AMBIT already - a short talk on AMBIT
** Explain the various [[AMBIT Training routes]] that are available
** Explain next steps - [[PREP day: Overview]]
** Coach on how to facilitate and prepare for the PREP day
*The AMBIT Lead Trainer records the conversation on the Expression of Interest form, including actions, and sends to the AMBIT Project Coordinator
>>Previously, this initial assessment was achieved via [[Pre-training team audit]], but recognition of the need for even //more// preparatory work has led to this being superceded by the PREP day.
!3. PREP day (Preparation, Reflection, Evaluation and Planning)
This process has replaced the previous [[Pre-training team audit]]
* The intention is that this day should be useful to teams //whether or not they go on to engage in AMBIT training//, and is charged for separately from any future AMBIT training.
* It involves teams engaging ''prior to the day'' with some evaluation questionnaires beforehand
|bgcolor(pink): <br>See the [[AMBIT PREP day website|http://ambit-prep.tiddlyspace.com]]<br> |
* The PREP day consists of a series of three meetings/exercises, attended variously by senior managers, clinicians, and all staff.
** These are hosted by two [[AMBIT Trainers]]
|bgcolor(pink): <br>See the [[PREP day: Overview]]<br> |
!4. Application Review and Acceptance
* On the strength of the PREP day, the application is reviewed, and a decision will be made jointly about whether the team wants to proceed with [[AMBIT training]], and if so, by which [[route|AMBIT Training routes]].
* Reviewing trainers respond to pre-training audit with their mentalized understanding of the team and their challenges (by video, or letter)
* The team is invited to correct any inaccuracies in this account before training begins
* Arrangements for training finalised with [[The AMBIT Project Coordinator|mailto:ambit@annafreud.org]]
!Note
*At any stage in the application process, it may be helpful for teams to hold a [[Briefing session for senior managers/commissioners]]

* ''The intention of the AMBIT project at the [[AFC]]'' is to provide free, OpenSource resources for supporting and developing effective practice with young people whose needs are multiple, complex, and who are subject to social exclusion and who may not be seen as "help-seeking" in conventional terms.
* ''"//There is no such thing as an AMBIT team//"'':
** We talk instead of [[AMBIT-influenced]] teams
** AMBIT is focused on supporting IMPROVEMENT in relation to locally-defined organisational/service goals.
** We are, however, looking at developing an option for teams/organsations to become [[AMBIT-accredited]].
* In pursuit of these locally-defined service goals, AMBIT training is designed to:
** ''Support'' [[LEARNING at work]] so that local teams can develop, record and broadcast their own excellence and learning.
** ''Provides a robust foundation of theory and integrated practices''
*** (see [[AMBIT: an overview]], and note the explicitly evidence-based and manualized interventions here: <<tag [[Specific interventions]]>> which are integrated within the broader framework of AMBIT. The content of AMBIT //has been shaped by the >90 teams trained to date// (2015), with encouraging early outcomes data published (see [[Academic references]]).
** ''Share all of our [[Training exercises]]'' that have been found to be helpful over multiple trainings.
** ''Encourage wide dissemination through supporting'' locally-delivered training sessions:
*** <<tag [[Local AMBIT training session plans]]>>
* ''There is no rigidly fixed method of being trained in the AMBIT approach'', but note the following:
** ''We do NOT train individuals in AMBIT'' - it is a team approach
** The main pathways for training are listed in the table at [[AMBIT Training routes]]

The ''Standard whole team training route'' is laid out as no. 01 in the table below.
''Ongoing Evaluation:''
* We are starting to evaluate the outcomes of the first two of these different training routes, but at present there is insufficient data to support one method over another.
* See [[Training Day 1 and 2 Testimonials]], [[Lead Training Testimonials]] and [[Training Day 5 Testimonials]] for feedback from previous trainees (quoted with their permission).
''Variety/Choice:''
* In all likelihood the range of different needs from different teams will continue to justify this range of different models for dissemination.
|bgcolor(pink):''01.'' [[AMBIT Basic Five Day Training]] |bgcolor(pink): ''Advantages / Disadvantages / Discussion'' |
|bgcolor(lightblue):''(a) Multi-team trainings'' (for up to 5 or 6 teams together) |bgcolor(lightgray):Advantages in fostering across-team and geographically dispersed connections/comparisons and learning, and promotes value of the [[Community of Practice]] |
|bgcolor(lightblue):''(b) Bespoke trainings'' (for one or more teams from a single larger organisation) |bgcolor(lightgray):Advantages in being focused on a specific organisational setting, but reduces benefits from multi-agency connections |
|bgcolor(pink):''02.'' [[Training the Trainer (TTT) - training model]] |bgcolor(pink): |
|bgcolor(lightblue):''(a) Training AMBIT local (UK) trainers'' via training days dispersed over a period of months, who are simultaneously supported via supervision to train their own local teams over a period of a year. |bgcolor(lightgray):Advantages of embedding local expertise in teams, disadvantages in loss of a //whole team "experience"// to support team culture change, and the value of 'disinterested' outside trainers to encourage change |
|bgcolor(lightblue):''(b) Training international AMBIT local trainers'' in a 5 day block, who are then supported via web-based tele-supervision to train their own local teams over a period of a year. |bgcolor(lightgray):Ditto above, intense week allows immersion in content and development of international peer group support, but a lot to take in quickly (feedback positive, though). |
|bgcolor(pink):''03.'' [[AutoDidact]] ''training'' |bgcolor(pink): |
|bgcolor(lightblue):We have heard of some ''teams using the manual content to deliver their own self-directed training'' completely independently from the AFC and the AMBIT project. |bgcolor(lightgray):This is quite inspiring to us, fulfilling the ambition of AMBIT to be an [[OpenSource]] approach to treatment innovation and dissemination, however, to date we've not had any feedback from these teams: we would be very keen to hear about their experiences! |
|bgcolor(pink):''04. Advanced and Practice Days'': |bgcolor(pink): |
|bgcolor(lightblue):(a) [[AMBIT Leads Practice Day]] |bgcolor(lightgray):A day for existing [[AMBIT Lead]] workers - rehearsing, refreshing and developing practice in supporting existing AMBIT-influenced teams |
|bgcolor(lightblue):(b) [[Follow-up training for established teams]] |bgcolor(lightgray):A 2 day training for a team that has previously been trained, but which has had new staff who have arrived AFTER the original training |
|bgcolor(lightblue):(c) [[Special Skills Training Days]] |bgcolor(lightgray):Days on specific areas of practice, such as [[Formulation and Treatment Aims]], the use of the [[AIM]] assessment, [[SupervisoryStructures]], etc (UNDER DEVELOPMENT). |

For AMBIT's 4th annual conference, on 2nd June 2016, we ditched the traditional conference format adhered to in previous years in favour of a style more in keeping with the AMBIT's tradition of co-creation and the project's ambitions to foster and sustain a [[Community of Practice]] for AMBIT-influenced teams and individuals: the ''unconference''. The [[unconference | https://en.wikipedia.org/wiki/Unconference]] format provided a loosely structured space for peer-to-peer sharing of ideas, good practice and learning.
At the beginning of the day, participants were invited to make a note on small pieces of paper of particular conversations they would like to lead or take part in. These ideas were then mapped to the quadrant of the [[AMBIT Wheel]] to which they most related, and organised into five "Unconference Conversation" topics for each quadrant: [[Working with your CLIENT]], [[Working with your NETWORKS]], [[LEARNING at work]] and [[Working with your TEAM]]. We then had a participant-created schedule for the morning, with sessions relating to each quadrant to run concurrently in separate rooms. The schedule was displayed on a board so that participants could choose their own timetable for the morning:
<<image [[Unconferenceboard]]>>
Notes made by facilitators in each unconference conversation are available here, arranged by quadrant.
|bgcolor(pink):<<tag [[Working with your CLIENT Unconference Conversations]]>>|
|bgcolor(lightgreen):<<tag [[Working with your NETWORKS Unconference Conversations]]>> |
|bgcolor(yellow):<<tag [[LEARNING at work Unconference conversations]]>> |
|bgcolor(lightblue):<<tag [[Working with your TEAM Unconference conversations]]>> |
In the afternoon we played some games designed to prompt thinking about [[Dis-integration]] (which involved silly glasses and balloons) and the use of the [[Community of Practice]] (which involved post-it notes on foreheads and long bits of elastic). We also offered three short, pre-planned talks with a view to sharing practice, sparking conversation and seeking feedback and collaboration:
*AMBIT training across a locality - James Wheeler
*Thinking about the AMBIT Wheel from a young person's perspective - Dickon Bevington
*Starting an AMBIT-influenced team from scratch: establishing a partnership between the AMBIT Project and an NHS healthcare team - Liz Cracknell
A "cafe corner" was open all day to create a space for those serendipitous encounters with fellow participants which feedback from previous conferences tells us sometimes create the most valued learning opportunities.

See also the [[Core Features of AMBIT]] for text and video to support this diagram.
!!!Download!
You can Download the AMBIT Wheel diagram as a PDF [[here|https://docs.google.com/file/d/0B5h_CVBdhJPYUjFXUk9MOVJfQ0E/edit?usp=sharing]]
!!!Diagram:
Click on where you want to go (or scroll down for more content.)
[img[AMBIT wheel 2014_SMALL]]<<imageMap MapWheel_2014>>
!Explanation
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!There's more: a client's version
The AMBIT Wheel is primarily designed for the benefit of workers - helping them to map or [[mark|Marking the Task]] and [[balance|Holding the Balance]] the range and scope of their work tasks.
A new development currently under review is a "matched" (segment-for-segment) version, the [[Client's AMBIT Wheel]]. Early feedback about this from practitioners at the 2016 AMBIT conference was positive - as a way of shaping workers' understanding of their work from the client's point of view. Whether sharing it with clients (as a form of PsychoEducation aid) adds any value is undetermined as yet.
!!Feedback from AMBIT-influenced teams
>>"We have found that we have managed to embed use of the 'Wheel' in the team meeting (members elect to think with a view to a particular quadrant)"
>>> AMBIT-influenced team, 2014

!This is Work in progress!
Ideas of Integration, Dis-integration, Working alongside, Co-construction and Co-production
See page on [[Signs of Safety]] for an example
See John Burnham paper - "Approach, Method, Technique

!The problem AMBIT is designed to help with
Socially excluded youth with mental health problems and co-occurring difficulties (e.g. conduct disorder, family breakdown, homelessness, substance use, exploitation, educational failure) attract the involvement of multiple agencies. Poorly coordinated interventions often multiply in the face of such problems, so that a young person or family is approached by multiple workers from different agencies working towards different goals and using different treatment models; these are often overwhelming and may actually be experienced as aversive by the young person or their family. Failure to provide effective help is costly throughout life (effective early intervention in conduct disorder alone is estimated to save £150,000 per child; Friedli, 2007).
!What is AMBIT?
AMBIT is a framework to support developing practice, rather than a self-contained model of therapy.
AMBIT is a collaborative project that involves feedback from practitioners, clients and evidence based treatment designers. It has been designed by and for community teams from Mental Health, Social Care, Youth work, or that may be purposefully multi-disciplinary/multi-agency. It emphasises the need to strengthen integration in the complex networks that tend to gather around such clients, minimising the likelihood of an experience of care that is aversive. AMBIT uses well evidenced ‘[[Mentalization]]-based’ approaches, that are at their core //integrative// (drawing on recent advances in neuroscience, psycho-analytic, social cognitive, and systemic "treatment models"). Evaluations at local levels have offered very promising results, and to date (2014) over 80 teams have been trained in the UK, Switzerland and USA. Publications in peer reviewed journals and presentations at international conferences have been well received, and demand for AMBIT training is very high.
AMBIT uses evidence based approaches developed for self-injurious, substance-using and often non-help-seeking, disaffected and socially excluded youth. It offers a robust framework within which to coordinate and integrate interventions from a range of agencies, which address complex problems that occur at the same time across a range of domains (from the //biological//, through //individual psychological//, //family//, and //social// interventions, and including //Education// and //legal/forensic// services.) At its core is the treatment model based on the science of “[[Mentalization]]” that has achieved strongly evidenced results with the condition known as adult borderline personality and also with adolescent self-injurious behaviour. AMBIT is being applied in a widening range of treatment settings. Mentalizing theory is favoured because it is intrinsically //respectful// to other schools of thinking, and it is relatively easy to train workers in the core competencies. AMBIT places a very powerful emphasis on developing //strong supervisory relationships// between teams of workers, who are thus supported to form strong individual relationships of trust with young people, while close attention to professional peer relationships counters the risk of such client-worker relationships themselves becoming a destabilising influence, as is unfortunately often the case in this field.
A key goal in AMBIT is to improve young people’s [[Relationship to help]], to improve the likelihood of more adaptive help-seeking in the future, as well as addressing current symptoms, so prevention is at the heart of the AMBIT method of working.
AMBIT applies mentalization-based principles and practices in four main areas:
>(a) In ''direct work with clients'' (young people and their families or carers)
>(b) In shaping and supporting ''relationships between workers in teams''
>(c) In providing systematic approaches to identifying and addressing “dis-integration” ''in the complex multi-agency networks'' that gather around such youth
>(d) In ''supporting local teams to adopt a learning stance'' towards their own practice, so that AMBIT is not simply a “one-size-fits-all” approach but supports the gathering of //local outcomes evidence//, and the use of this //to develop a judicious balance between the use of existing evidence-based ways of working, and the onwards development of local practice that is culturally sensitive to the needs of local youth and to the organisational contexts in which this care is delivered//.
AMBIT’s model for disseminating its knowledge and practices attempts to ''balance'' //centrally designed interventions// with constrained //local adaptation of the model to fit local systems, client groups, and onwards learning//. It is supported in this by AMBIT’s national award winning wiki-based “manualizing” technology (http://www.tiddlymanuals.com).

A rather hurried but packed conversation:
* ''Where to start?''
** How to introduce an organisation to AMBIT
** How to introduce AMBIT to the organisation
* We discussed the ''usefulness of the theory of'' [[Dis-integration]] - as the "natural resting state" of all complex multi-professional [let alone multi-agency] networks.
** Establishing this ''reduces the likelihood ''professional shame'''' in talking about this (and reduces the possibility of workers in trouble shrinking away from help-seeking.)
* We discussed how critical it is to have ''Top-down and bottom-up conversations with staff in the organisation'' (senior managers/commissioners/CEO's AS WELL as street level workers; the latter are often easier to engage with the material and ideas.)
** Beware senior managers who engage AMBIT trainings more because "We need to spend this money before the end of the year, or it will be taken away from us" than because of an understanding of authentic need in the team.
** Discussion of the PREP day of pre-training preparation (see [[PREP day: Overview]])
** Never seems to have been as much senior management engagement as we wanted/thought we had achieved before the event!
* ''Barriers to discussion with senior management/commissioners''
** More difficult for managers to acknowledge a "learning gap" in their team, and to acknowledge their own need to understand what might be seen as "detailed clinical practice"...
** Easy to misunderstand the systemic/organisational implications of an AMBIT training
** Do the people commissioning AMBIT training understand what it is they are inviting in?!
* ''Upwards conversations "By Stealth"''
** Small influential "corridor conversations"
** Talking "their language" - especially [[Outcomes]].
*** see other discussion on [[Does AMBIT work? (Unconference conversation 2016)]]
*** Use of [[Elevator Pitch]] exercise with team: ''can you create an elevator pitch that summarises in 1 minute:''
**** The goals of the (training) project?
**** The Barriers to successful completion of the team's [[Implementation Plan]]
**** Proposed solutions to these barriers?

AMBIT is in some senses a way of working with young people before they are ready to receive more mainstream forms of help.
[[Active Planning]] provides:
|bgcolor(lightgrey): ''A framework for developing relationships'' where [[Epistemic Trust]] can be established |
And together with the other elements of [[AMBIT|AMBIT: an overview]] seeks to provide:
|bgcolor(lightgrey): ''A context in which therapeutic change is most likely to become possible'' |
It aims to capture some core dilemmas and practices that may assist with managing this, which are described as the [[Core Features of AMBIT]].

The AMBIT project is co-led by [[DickonBevington]] and [[Peter Fuggle]] and Deputy Lead [[Liz Cracknell]] at the [[Anna Freud National Centre for Children and Families]] and, along with the other original [[Authors]], includes:
* Administrative support
** Anna Smith, Project Co-ordinator ([[ambit@annafreud.org|mailto:ambit@annafreud.org]])
* A growing number of [[AMBIT Trainers]] drawn from active [[AMBIT-influenced]] teams

This is a means of helping a team to [[SUSTAIN best practice]] in their day to day work during [[Team Meetings]].
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A set of playing cards with the each of main elements of the AMBIT stance (see [[Core Features of AMBIT]]) printed on one, is shuffled and the cards are dealt - one to each team member - at the beginning of a team meeting.
The holder of each card becomes a "stance monitor" for that particular aspect of practice during case discussions, trying to keep a focus for that meeting on whether there are particular aspects of practice influenced by that element of the stance that should be emphasised.
This technique works best if a certain amount of playfulness is allowed to lubricate the serious intent underlying it. Stance bingo is an alternative that has been suggested...

!!Introduction
This page provides an overview of ''//training//'' in AMBIT and links to all aspects of the training in the manual (click the "Show references and info" panel above right, to see links to and from this page).
!!Curriculum
|bgcolor(lightblue):<br>To get an idea of the curriculum see ''1.'' [[AMBIT: an overview]] and ''2.'' [[AMBIT Competencies]].<br> |
!!Principles behind AMBIT's approach to training:
|bgcolor(pink): <br><<slider "TrainingPrinciplesSlider" "AMBIT Training Principles" "Click to see AMBIT's Training Principles">><br> |
!!Considering training? Practical advice about applications.
|bgcolor(lightblue):<br>''1. There is'' [[Guidance for Teams Considering Applying for Training]].<br>''2. There is an'' [[AMBIT Training Application Process]]<br> |
!!AMBIT training routes:
|bgcolor(lightgreen):<br>There are a variety of different ways to get AMBIT training<br><<slider "TrainingRoutesSlider" "AMBIT Training routes" "Click to see the different Training Routes/Options">><br> |
!!Training resources in this manual
|bgcolor(lightblue):<br>''1. Our [[Training exercises]] are all included within this manual'' to encourage and support ongoing local training.<br>''2. Our [[Training slides]] are all freely available'' under a [[creative commons license|Licensed]]<br>''3. The [[AMBIT Training Tour]] (under construction, June 2015)'' will include, gather and organise in sequence all the major didactic teaching content from AMBIT trainings.<br> |
!FAQ's (Frequently Asked Questions)
|bgcolor(pink):<br>See [[AMBIT FAQs]]<br> |
!Who trains?
AMBIT training is delivered by [[AMBIT Trainers]] who are experienced practitioners either working at the [[Anna Freud National Centre for Children and Families]] or working in teams that have made use of the AMBIT approach.
!!Where is training delivered from?
Training in [[AMBIT]], is offered via the [[Anna Freud National Centre for Children and Families]] - there is a link to the training page in the AFC website describing the core components of the 4 day AMBIT team trainings [[here|http://www.annafreud.org/courses.php/14/the-basic-ambit-training-4-days]].
!History and other background information
By 2015 this training has been delivered to over 90 teams (>1000 workers) in the U.K, //developing as it goes//, in keeping with the "Deployment-focused" approach to treatment development that AMBIT aspires to (see [[Weisz, Simpson-Gray (2008) Evidence-Based Psychotherapy for Children and Adolescents]] and [[Bearman et al (2010) Adapting CBT to fit diverse youths and contexts: applying the deployment-focused model...]])
!!Individual practitioners
Individuals are occasionally offered introductory trainings via the [[Anna Freud National Centre for Children and Families]], which address the overarching theoretical framework, experiential training with a number of 'tools', and a brief introduction to the manualization aspects of [[AMBIT]]. However, ''full trainings are not offered to individuals'' as [[AMBIT]] is, above all else, a ''team practice''.